Recommendations for hepatitis care in drug users

In high-income countries, the majority of all new hepatitis C virus (HCV) infections occur in people who inject drugs (PWID). Large HCV epidemics have also occurred in PWID populations in many low- and middle-income countries. Increasing numbers of PWID are developing liver inflammation caused by hepatitis C virus (HCV), but treatment uptake remains extremely low. There are a number of barriers to treatment that need to be considered and systematically addressed. PWID should not be excluded from HCV treatment. The rapid development of interferon-free HCV therapy with direct-acting antiviral (DAA) agents has given rise to great optimism in the field of HCV treatment and to the realistic assumption that a therapeutic intervention will soon achieve near-optimal efficacy with well-tolerated oral therapy regimens of short duration. Furthermore, it has been clearly demonstrated that HCV treatment is safe and effective across a wide range of interdisciplinary healthcare settings. Given the HCV-related diseases among the PWID population, there is an urgent need for strategies to improve HCV diagnosis and treatment in this group. These recommendations demonstrate that treatment can be implemented in PWID and provide a framework for HCV diagnosis and treatment. Further research is needed to evaluate strategies to improve testing, delivery to treatment, therapies, adherence and cure of viral disease, and prevention of reinfection under PWID as new interferon-free DAA therapies for HCV infection become available.