Hepatitis C virus elimination entails prioritization, not exclusion, of drug users

Liz Meszaros, MDLinx | September 16, 2017

Worldwide elimination of hepatitis C will require strategies to prioritize drug users and their treatment, according to experts from around the world attending the 6th International Symposium on Hepatitis Care in Substance Users, held in New York.

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Hepatitis C in drug users

Of the estimated 71.1 million people with chronic hepatitis C worldwide, 8% of those living with the disease and almost 25% of new infections are in drug users.

"The number of people around the world dying from hepatitis C is increasing. We have the tools to reverse this trend, to eliminate this disease and save millions of lives. But it will not happen until people who use drugs become a focus of our efforts," said Jason Grebely, associate professor, Viral Hepatitis Clinical Research Program, Kirby Institute, faculty of medicine, University of New South Wales, Sydney, Australia, and president of the International Network of Hepatitis C in Substance Users (INHSU).

Of the estimated 71.1 million people with chronic hepatitis C worldwide, 8% of those living with the disease and almost 25% of new infections are in drug users.

The advent of new and highly effective curative treatments has led to a hope for a world free of hepatitis C. In Australia, the goal is to eliminate hepatitis C as a public health concern by 2026 via a new public health strategy to offer treatment to all those affected, with no restrictions, and the prioritization of those who use drugs.

Despite this, in the US and other countries, testing for hepatitis C, linkage to care, and treatment for individuals who use drugs remains low.

Treatment is vital for elimination of hepatitis C, is cost effective, and reduces onward transmission. Previous studies done in Scotland, Australia, and Canada demonstrated that a 3- to 5-fold increase in treatment of drug users may work to reduce the prevalence of hepatitis C by 15% to 50% within 10 years.

The elimination of hepatitis C in drug users, however, will require careful integration with harm prevention programs and linkage to care, and a review of the policies that may drive the spread of this disease.

Researchers at the conference presented studies showing that opioid substitution therapy (OST) and needle and syringe programs (NSP) could reduce the incidence of hepatitis C by up to 80%. They also showed that response to new hepatitis C direct-acting antiviral agents (DAA) among drug users is high and reinfection low. 

Finally, they found that community involvement is vital to successful implementation of such programs.

"Access to good quality healthcare should be a basic human right for any person, irrespective of whether they use drugs. But when providing this, it also means we are able to eliminate a disease currently affecting 71 million people around the world, then taking action becomes even more of a moral and public health imperative. We cannot afford to delay any longer," concluded Grebely.

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