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Guide to Hepatitis C for People Living With HIV
Testing, Coinfection, Treatment and Support

By Simon Collins and Tracy Swan

August 2007

HCV Treatment and People Who Use Drugs

Hepatitis C treatment has traditionally been withheld from injection drug users, even though current treatment guidelines recommend that treatment decisions be made on a case-by-case basis. Fortunately, this has begun to change. Experience with HIV treatment confirms that it is possible for drug users to adhere to ARVs; moreover, response rates from clinical trials of HCV treatment in IDUs are similar to those reported in non-users.

Don't avoid medical care just because you are using. Many drug users with HCV are being monitored regularly for disease progression and some have begun and completed HCV treatment with Pegasys or PEG-Intron.

It is important to find a doctor who is willing and able to work with drug users and who will treat your HCV. Ask other drug users to recommend a doctor -- or to warn you about which ones to avoid.

Try hard not to miss medical appointments, since some doctors will use missed appointments as part of the criteria for deciding whether or not they will treat your HCV. Even if you think your HCV treatment side effects are insignificant, discuss them with your doctor and ask up front how he or she plans to help you manage these side effects so you can get through treatment. If you need pain medication, anti-anxiety drugs, or other medications sometimes associated with "drug use/abuse," discuss this openly with your doctor before you begin treatment. Be assertive and make an agreement on how the two of you will handle this should the issue arise.

Depression and other mental health diagnoses are much more common among people with HCV, people with HIV, and drug users than in the general population. Many of these conditions can be treated successfully.

People with a history of depression are more likely to develop depression during HCV treatment, although it can happen to people who have not been depressed in the past. If you are concerned about the psychiatric side effects of HCV treatment but want to treat your hepatitis C, consider professional mental health care.

Some people can manage HCV treatment while they are using drugs; others have found that stopping or cutting down on drug use help them prepare for, and stay on, HCV treatment because they feel more stable. Some therapy choices may include a self-help program; counseling; drug treatment; heroin substitution; methadone maintenance; naltrexone implants; and buprenorphine.

If you are still injecting drugs, ask your doctor or local syringe exchange program for information on safer injection practices to lower your risk of HCV re-infection (and other infections).


Working With Your Clinicians

  • Make sure to work with health care providers that take the time to answer your questions about HCV treatment and side effects.
  • Make a list of questions before going to the doctor and bring someone with you if possible.
  • Keeping medical appointments is especially important after you start your HCV treatment; your doctor needs to be able to regularly monitor your health and help you with side effects.
  • If you need pain medication or other medications with abuse potential, discuss this with your doctor; make an agreement on how the two of you will handle this.
  • Identify people in your life who are, or will be, a good source of support for you.
  • Consider joining a support group.


Concerns for People in Recovery

Because the side effects of interferon are very similar to opioid withdrawal, many people in recovery fear that they will relapse to active drug use. The risk of relapse is lower when side effects are promptly treated and counseling and support from peers and medical and mental health providers is available.

Some people are concerned about self-injecting pegylated interferon. If possible, the once-weekly injections can be given at a doctor's office or clinic to avoid triggering a relapse to injection drug use.


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