Hepatitis C virus and injecting drug use: what are the challenges?

• Published in: Clinical Dilemmas in Viral Liver Disease pp. 78 - 81
• Main Author: Dalgard, Olav
• Format: Book Chapter
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 25.03.2020
• Subjects: hepatitis C virus; liver fibrosis; needle and syringe programs; opiate agonist therapy; people who inject drugs
• ISBN: 9781119533399; 1119533392
• DOI: 10.1002/9781119533481.ch13

The consensus among experts involved in hepatitis C virus (HCV) elimination programs is that management and treatment of people who inject drugs (PWID) will be key to any successful elimination initiative. The most immediate challenge will be to identify those who have developed advanced liver fibrosis or cirrhosis and who are at risk of developing liver failure, hepatocel‐lular carcinoma, and death. Halting the transmission of HCV among PWID is another challenge that needs to be addressed. Needle and syringe programs combined with opiate agonist therapy have been shown to reduce the incidence of HCV by 75%. Mathematical modeling suggests that elimination of HCV among PWID can best be achieved by providing harm reduction in combination with treatment as prevention. It has been shown that as soon as a PWID is engaged in HCV care, treatment results are excellent and comparable to those achieved among people not injecting drugs.