Public Health

Restrictive criteria may deny treatment to most HCV-infected drug users

Last Updated: 2006-03-21 12:55:58 -0400 (Reuters Health)

NEW YORK (Reuters Health) - The application of multiple exclusion criteria for anti-hepatitis C virus (HCV) treatment may mean that the majority of young injection drug users would be denied treatment, warn a group of clinicians in the March 1st issue of Clinical Infectious Diseases.

Hepatitis C is highly prevalent in injection drug users, but they face difficulties in adhering to treatment, Dr. Holly Hagan from the Center for Drug Use and HIV Research in New York and colleagues point out. Recent guidelines recommend that practitioners determine on an individual basis whether drug users should be offered HCV treatment, but the researchers say many physicians "still choose to apply restrictive criteria."

Dr. Hagan's team found that among a sample of 404 HCV RNA-positive injection drug users between 18 and 35 years of age, 96% had conditions that represent "potentially unwarranted" contraindications to anti-HCV treatment.

These contraindications included problem drinking or moderate-to-severe depression (63%) and recent drug injection (89%).

Given that younger patients are more likely to respond to anti-HCV treatment, "factors used in screening for treatment eligibility in this group should be limited to those that clearly reduce the effectiveness of treatment or increase toxicity," Dr. Hagan and colleagues assert.

Two researchers from the Center for the Study of Hepatitis C at Weill Medical College of Cornell in New York agree, adding in an editorial that "a growing number of studies" suggest that drug users treated for HCV infection can achieve sustained virologic response rates similar to other populations, even if they have psychiatric comorbidities or continuing to use drugs during treatment.

When restrictive criteria are applied to substance users with HCV infection, the proportion that remains eligible for antiviral therapy "quickly evaporates," Drs. Brian R. Edlin and Michael R. Carden write.

Injection drug users make up the core of HCV epidemic in the developed world, they point out. This "is the battleground on which efforts to control HCV infection in the developed world will be won or lost."

Clin Infect Dis 2006;42:669-675.