Ethical issues in the treatment of hepatitis C

Area of Science:

• Hepatology
• Infectious Diseases
• Public Health

Background:

• Hepatitis C virus (HCV) is the most common blood-borne infection in the US, affecting 4 million Americans.
• Disadvantaged populations, including prisoners and individuals with psychiatric disorders, exhibit higher HCV prevalence.
• Significant ethical, clinical, economic, and social barriers impede access to effective HCV antiviral treatments for these groups.

Purpose of the Study:

• To analyze clinical-ethical arguments limiting HCV treatment access for disadvantaged populations.
• To explore strategies for overcoming barriers to HCV treatment in vulnerable groups.
• To enhance gastroenterologists' understanding of ethical and social justice issues in HCV care.

Main Methods:

• Analysis of five clinical-ethical arguments: risk/benefit balance, justice, compliance, cost-effectiveness, and discrimination.
• Review of literature on barriers to HCV treatment access.
• Examination of collaborative care models for managing HCV in disadvantaged populations.

Main Results:

• Psychiatric and substance use interventions can optimize cost-effectiveness and risk/benefit balance for treating disadvantaged groups.
• Collaborative care improves adherence and reduces adverse effects, despite potential higher rates of psychiatric side effects and poorer compliance.
• The principle of justice supports treating these populations if adherence and risk/benefit profiles are comparable to other groups.
• Discrimination significantly reduces care access for prisoners and stigmatized populations with HCV.

Conclusions:

• Active collaboration between gastroenterologists and mental health/substance abuse professionals can expand safe and effective antiviral therapy access for disadvantaged HCV populations.
• Addressing ethical and social justice barriers is crucial for equitable HCV treatment.
• Integrated care models are key to overcoming treatment challenges in vulnerable patient groups.