Barriers to receiving hepatitis C treatment for people who inject drugs: Myths and evidence

BACKGROUND: Alcohol consumption, current injecting drug use, and pre-existing mental illness have been identified as 3 of the main reasons for excluding patients from treatment for hepatitis C. OBJECTIVES: We reviewed the literature to obtain an evidence base for these common exclusion criteria. MATERIALS AND METHODS: We reviewed original research and meta-analyses investigating the effects of alcohol consumption, current injecting drug use, and pre-existing mental illness. RESULTS: We identified 66 study reports relevant to the review, but found only limited evidence to support withholding of treatment on the basis of the 3 previously mentioned exclusion criteria. CONCLUSIONS: Currently, there is a lack of evidence for many of the barriers faced by patients in availing treatment for hepatitis C. Adherence to treat routine was found to be a better predictor of sustained virological response than injecting drug or alcohol consumption during treatment period or the presence of a pre-existing mental disorder. Although several challenges remain, we need to ensure that treatment decisions are based on the best available evidence and the treatment is performed appropriately on a case-by-case basis.