Hepatitis C and substance use: new treatments and novel approaches

To provide an update on new treatment approaches for patients with hepatitis C virus (HCV) infection and substance use. This issue is of extreme importance for HCV, as many patients have substance-use histories.

Recent emergence of two new protease inhibitors, boceprevir and telaprevir, to enhance the modern treatment of HCV have boosted the sustained virologic response rate to about 80%, a 30% increase over prior standard of care with interferon and ribavirin. Unfortunately, many providers are reluctant to treat patients with substance-use histories unless they have demonstrated abstinence for at least 6 months, and there is a spoken and unspoken bias against these patients. Emerging new studies have shown that even current injection drug users can be treated successfully with results comparable to patients who are abstinent and those with no drug-use histories, especially with attention to the patient's substance use and other psychiatric problems.

Newer treatment approaches for HCV will help many more patients than ever before to overcome the virus. Changed attitudes and innovative approaches to patients with substance-use histories are needed to bring these scientific advances to this segment of the population of patients with HCV.