Undergoing Treatment

  • The prospects for successful treatment of viral hepatitis diseases in drug users are similar to those for patients who do not suffer from an addictive disorder. However, the treatment should be administered by doctors or in medical establishments, where they have experience and the necessary knowledge of diseases relating to addiction and also of the particular problems associated with viral hepatitis infections.
  • Providing information consistently to the individual and explaining to hepatitis C-positive drug users about treatment is vital.
  • A key aim of the treatment is the elimination of the hepatitis C viruses, as a result of which the possible consequences of the infection, particularly chronic progressive liver damage, can be prevented or stopped.
  • They are four subgroups of the hepatitis C virus in Western Europe (genotypes 1 to 4). The success rate of treatment for genotypes 2 and 3 is between 70% and 90%. For genotype 1 a full recovery is achieved in around 50% of cases, and the figure for the relatively rare genotype 4 is somewhat higher.

Indication

According to our present state of knowledge, the following criteria are to be taken into account when deciding to carry out a hepatitis C treatment:

  • The virus (HCV RNA) is detectable in the blood and the indication is found in the histology, i.e. portal fibrosis and septa are detectable.
  • There are no contraindications, such as uncontrolled depression or psychosis, advanced heart, lung or neurological diseases, uncontrolled alcohol abuse or intravenous drug use.
  • The patient is informed about the prospects of success of the treatment, the potential side effects and the risks of the disease progressing if the therapy is not carefully followed.
  • The ability of the patient to adhere to the therapy and the follow-up appointments, and/or creation of a setting that promotes adherence for the administration of the therapy.

Further points to be noted

  • It is recommended to combine a hepatitis C therapy with an opiate replacement therapy and corresponding counseling, wherever possible. It is often useful to temporarily increase the methadone or heroin dosage during therapy.
  • Hepatitis C therapy, while undergoing drug withdrawal treatment or less than 6 months thereafter, is contraindicated due to the high rate of relapse.
  • Hepatitis C therapy is feasible for prison inmates and longterm in-patient situations. Adherence to therapy and follow-up appointments is especially well ensured in such settings.

Treatment can be given in instances of sporadic incidental drug use under hygienically appropriate conditions and where the quantities involved do not occasion any cognitive impairment.
In the case of persistent, uncontrolled, intravenous, inhalation-based or pernasal drug use, the advice is not to administer a treatment.