Hepatitis C Virus Infection and Substance Abuse: Medical Management and Developing Models of Integrated Care—An Introduction

Abstract

Reprints or correspondence: Dr. Thomas F. Kresina, Div. of Pharmacotherapies and Medical Consequences of Drug Abuse, National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Blvd., Bethesda, MD 20892 ([e-mail]). Clinical Infectious Diseases 2005; 40:S259–62 2005 by the Infectious Diseases Society of America. All rights reserved. 1058-4838/2005/4009S5-0001$15.00 Persons who use illegal drugs, who have a history of illegal drug use, or who have become addicted to illegal drugs through injection drug use constitute a majority of the patients with incident hepatitis C virus (HCV) infection. These persons are at risk for other infectious diseases, such as HIV infection, and exhibit comorbidities associated with drug use, such as psychiatric illness. The medical management of HCV infection in these patients is complex and challenging. The 2002 National Institutes of Health (NIH) Hepatitis C Consensus Conference recommended treatment for HCV for injection drug users (IDUs), as determined on a case-by-case basis. This recommendation does not provide substantial guidance and support for healthcare providers dealing with the complex and challenging health-care issues associated with substance abuse and hepatitis C. To elucidate more fully the NIH Consensus Conference Statement on issues related to substance abuse, the National Institute on Drug Abuse of the NIH sponsored a conference to address the clinical issues associated with HCV infection, care, and treatment in the context of drug use to define research gaps for future research initiatives. The conference was held on 11– 13 November 2003 in Washington, DC. Cosponsors included the Office of AIDS Research, National Institute of Allergy and Infectious Diseases, and National Institute of Diabetes and Digestive and Kidney Diseases of the NIH, the Department of Veterans Affairs, and the Health Resources and Services Administration. The conference brought together infectious diseases specialists, hepatologists, and those who care for persons with substance abuse, to identify issues in the treatment of patients with HCV infection and coinfection with HIV and HCV, to discuss the development of models for integrated care and treatment of patients infected with HCV and coinfected with HIV and HCV, and to identify gaps in knowledge that can be addressed by a research agenda.