Advocates
Urge Consideration of Hepatitis C Treatment for Active Injection Drug Users  | Advocates
with the Treatment Action group (TAG) have successfully urged hepatology experts
to change hepatitis C management guidelines to eliminate a recommendation that
substance users should be abstinent from drugs or alcohol for 6 months before
they are eligible for treatment. |
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By
Liz Highleyman  Historically,
many clinicians have hesitated to treated active injection drug users (IDUs) and
other active substance users for hepatitis C virus
(HCV) infection, due to concerns related to presumed inability to adhere to
therapy, poor tolerance of interferon side effects such as depression, and high
risk of reinfection due to continued needle-sharing.
Older
hepatitis C treatment guidelines typically recommended that substance users should
be abstinent for 6 months before being considered for anti-HCV
treatment. But
a growing body of evidence indicates that IDUs -- including people on methadone
who relapse into occasional use as well as individuals who continue regular active
injection -- can
achieve good treatment outcomes if they receive the support they need, especially
in a multi-disciplinary setting that enables access to multiple services at a
single site or with a single care team. Current
National Institutes of Health (NIH) consensus guidelines state that IDUs, especially
those on methadone maintenance or similar opiate substitution therapy, should
not be routinely denied hepatitis C treatment, but should be evaluated on an individual
basis. The
American Association for the Study of Liver Diseases (AASLD) published updated
practice guidelines for the diagnosis, management, and treatment of hepatitis
C in the April
2009 issue of Hepatology. Advocates
with TAG discovered that the AASLD guidelines, still included the 6 month abstinence
waiting period. After calling this discrepancy to the authors' attention, the
hepatology experts indicated that they would change the guidelines to agree with
the recommendations of the NIH consensus panel. Below
is an update from TAG describing the issue and the group's efforts. TAG
Collaboration Changes Updated
Hepatitis C Treatment Guidelines  In
April 2009, the American Association for the Study of Liver Diseases (AASLD) published
updated Hepatitis C Virus (HCV) Practice Guidelines. The Practice Guidelines are
a useful and influential tool for busy clinicians, who are often unable to wade
through tall stacks of research papers to discover the standard of care for diagnosis,
management and treatment of HCV.
Hepatitis
C is rampant among current and former injection drug users, since it is transmitted
by direct blood-to-blood contact. Untreated hepatitis C leads to cirrhosis in
20-30% of cases. HCV treatment, when successful, can eradicate the virus and halt
progression to cirrhosis, liver cancer and liver failure. Unfortunately,
HCV treatment is often withheld from current and former drug users, despite medical
need, stability and willingness to undergo it, and NIH guidelines recommending
HCV treatment decisions on a case-by-case basis since 2002. However, the field
has continued to lean towards restricting, not broadening HCV treatment access,
despite mounting evidence that current and former drug users can be safely and
effectively treated. Increasing
quality of, and broadening access to HCV treatment has been a cornerstone of TAG's
Hepatitis/HIV Project. TAG staffer Tracy Swan carefully monitors HCV treatment
guidelines to this end. When she and a colleague, Jen Curry, from Harm Reduction
Coalition, spotted an apparent contradiction in the recommendations for treatment
of active drug users, they jumped into action. The
updated Practice Guidelines suggested that a minimum of six months of abstinence
from drugs and alcohol should be a prerequisite for HCV treatment and consideration
of treatment for active drug users as part of a multidisciplinary approach. Swan
and Curry wrote to the authors, asking that "...Practice Guidelines [become]...
internally consistent in suggesting that clinicians broadly consider HCV treatment
for active drug users in the context of supportive, multidisciplinary care."
Their letter was published in July of 2009, along with a response from the authors.
Swan, Curry and their colleagues are delighted to report that the Practice Guidelines
will be amended accordingly.
8/14/09 Source
Treatment
Action Group web site.
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