Q J Med 2001; 94: 153-158
© 2001 Association of Physicians
Managing chronic hepatitis C acquired through intravenous drug use
From the Centre for Liver Research, University of Newcastle, Freeman Hospital 1 Specialist Drug and Alcohol Unit, Plummer Court, Newcastle upon Tyne, UK
Received 24 July 2000 and in revised form 1 December 2000
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.
Address correspondence to Professor M.F. Bassendine, Centre for Liver Research, 4th Floor, William Leech Building, The Medical School, Framlington Place, Newcastle upon Tyne NE2 4HH. e-mail: M.Bassendine{at}ncl.ac.uk