[Treatment of viral hepatitis in drug addicts]

Management of viral hepatitis in drug uses must follow a multidisciplinary approach within the framework of overall psychosocial, alcohologic, and medical care. Substitution is an important but not indispensable aspect. In patients who have achieved social, psychological and medical stability (possible initiation of antiretroviral treatment), antiviral treatments can be started and followed in the same way as for other patients. Prescriptions should aim at improving the liver disease and avoid progression to cirrhosis and complications. Ribavirin/interferon-alfa appears to be the combination of choice for first line treatment of hepatitis C (while waiting for combinations with protease inhibitors). Anti-HBV vaccination is the treatment of choice for the prevention of hepatitis B and D. Coordination and information sharing between health and social care partners is crucial for the management of these patients.