What are the treatment guidelines for hepatitis C (Hep C) in patients using alcohol or injection drugs?

Updated: Oct 07, 2019
  • Author: Vinod K Dhawan, MD, FACP, FRCPC, FIDSA; Chief Editor: BS Anand, MD  more...
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In 1998, Wiley et al reported that significant alcohol use (>40 g alcohol/day in women and >60 g of alcohol/day in men for >5 years) in patients infected with hepatitis C virus (HCV) resulted in a two- to three-fold greater risk of liver cirrhosis and decompensated liver disease. In addition, cirrhosis developed more rapidly in alcohol users. [137] Because of the risk that alcohol use poses for rapid liver fibrosis, hepatoma, and deleterious effects on treatment response, complete alcohol abstinence is recommended during treatment.

Practice guidelines from the American Association for the Study of Liver Diseases (AASLD) have recommended that HCV treatment not be withheld from patients who use illicit drugs or who are on a methadone maintenance program, provided they are willing to maintain close monitoring, including practicing contraception. [34, 138] However, the guidelines have also noted that "It is important to consider the individual issues that may affect the risks and benefits of treatment of HCV infection in persons who use illicit drugs, rather than to make categorical recommendations." [139]

The complexity of HCV treatment in these patients is aided by a multidisciplinary team approach composed of physicians, nurses, and substance abuse and mental health professionals.

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