Managing chronic hepatitis C acquired through intravenous drug use

• Published in: QJM : An International Journal of Medicine 2001-03, Vol.94 (3), p.153-158
• Main Authors: Jowett, S.L., Agarwal, K., Smith, B.C., Craig, W., Hewett, M., Bassendine, D.R., Gilvarry, E., Burt, A.D., Bassendine, M.F.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Antiviral Agents - therapeutic use; Biological and medical sciences; Disease Progression; Drug Therapy, Combination; Female; Hepacivirus - isolation & purification; Hepatitis C, Chronic - etiology; Hepatitis C, Chronic - therapy; Human viral diseases; Humans; Infectious diseases; Interferon Type I - therapeutic use; Liver Cirrhosis - drug therapy; Liver Cirrhosis - etiology; Male; Medical sciences; Middle Aged; Patient Acceptance of Health Care; Patient Compliance; Recombinant Proteins; Retrospective Studies; Reverse Transcriptase Polymerase Chain Reaction; Ribavirin - therapeutic use; RNA, Viral - analysis; Severity of Illness Index; Substance Abuse, Intravenous - complications; Treatment Outcome; Viral diseases; Viral hepatitis
• ISSN: 1460-2725; 1460-2393; 1460-2393
• DOI: 10.1093/qjmed/94.3.153

We retrospectively reviewed the provision and uptake of hospital services for 253 current and ex‐intravenous drug users with hepatitis C virus (HCV). Overall, 237 attended at least one clinic (mean age 32 years, 70% male, 43% on maintenance methadone); 81% had evidence of active viral replication and 137 agreed to a liver biopsy to assess disease severity. Of these 137, 24% had mild chronic hepatitis with a low risk of progression to cirrhosis, but 9% had cirrhosis (mean age 40 years, mean time since initial intravenous drug use 15.8 years). Only 50 of the 100 patients in whom antiviral therapy was indicated, commenced treatment; 18 (36%) have had a sustained virological response. The natural history or response to treatment of chronic HCV in those who acquire it through intravenous drug use is not different to that previously reported for post‐transfusion HCV. However, a substantial proportion default from follow‐up or decline further intervention. As intravenous drug use is now the main risk factor for acquisition of HCV, these data have implications for future delivery of care aimed at limiting the morbidity of chronic HCV, and limiting the spread of hepatitis C virus infection amongst intravenous drug users.