People who inject drugs have historically represented a population at high risk for hepatitis C virus. However, these patients are often wary of authority figures or entities that might draw attention to or monitor their behavior. This caution may negatively affect their incentive to pursue treatment. The significant side effects of interferon-based therapies – previously the standard of care for HCV -may deter patients even more than fear of authority, as the side effects include IFN-induced bone marrow depression, flulike symptoms, neuropsychiatric disorders, and autoimmune syndromes. These regimens are also complicated and time-consuming, requiring 6 months of injections and a great deal of adherence.
“These treatments were very complicated, with a lot of nasty effects,” John F. Dillon, MD, professor of hepatology and gastroenterology at the School of Medicine, University of Dundee, Scotland, told Healio Gastroenterology and Liver Disease. “There were dangers and risks about taking it, and it required a lot of adherence and monitoring, a lot of rules and regulations, which made it difficult for these patients.”
The advent of more effective, more convenient drugs for HCV has opened new possibilities for engaging and effectively treating PWID, and controlling HCV’s transmission in this population. Dillon spoke with Healio Gastroenterology and Liver Disease about the changing landscape in treating PWID for HCV.
Question: The introduction of these new medicines could mean a big change in how HCV is treated in PWID. Have things begun to change already?
Answer: They have in some areas, but further change is still needed. There are two factors that might prevent patients from getting these medications and being cured. First, the new drugs are very expensive; this has caused some noise in the press. The list prices in the [United] States are very high, and they vary across different countries. So, these are new and expensive drugs, and there has been a degree of rationing of these drugs to those with most advanced disease, and so it can still be difficult for PWID to gain access to these therapies. PWID still die from liver cirrhosis and other problems associated with HCV.