Guide to Hepatitis B for People Living With HIV

Section 7: HIV/HBV Treatment for People Who Use Drugs

Injection drug users are often discriminated against in health-care settings. Often they don't receive adequate care and are denied medical treatment, even when they need it. Fortunately, this has begun to change. Experience with HIV treatment confirms that it is possible for drug users to adhere to therapy and that they do respond to treatment at rates similar to non-users.

Don't avoid medical care just because you are using.

Many drug users with HBV are being monitored regularly for disease progression and some have begun, and are staying on, treatment. It is important to find a doctor who is willing and able to work with drug users. 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 you. Even if you think your 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 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 Peg-IFN 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 Peg-IFN, consider working with a mental health care provider.

Some people can manage treatment while they are using drugs; others have found that stopping or cutting down on drug use help them prepare for, and stay on, 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 and other infections.

Working With Your Clinicians Make sure to work with health-care providers that take the time to answer your questions about 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 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

Some people are concerned about self-injecting Peg-IFN for various reasons. Sometimes the once-weekly injections can be given at a doctor's office or clinic to avoid triggering a relapse to injection drug use; however, some insurers may not cover this service.