Effective methods to diminish the burden of hepatitis C virus (HCV)
infection among injection drug users (IDUs) require consideration of the epidemiology and natural history of both
hepatitis C and drug use. Most HCV
infections are due to injection drug use, and most IDUs have HCV
infection. In addition, HCV
infection often occurs with other medical problems, such as human immunodeficiency virus
infection and depression, which may complicate its recognition and management.
Infection with HCV can be fatal, but usually not until years later, and persons may be unaware of the
infection, allowing an individual to infect many others. Effective treatment is available for HCV
infection; however, the
therapy is prolonged, involving both weekly
injections and daily oral medication, and is typically associated with significant adverse effects, such as
fatigue, depression, and, rarely, life-threatening complications. Although clearly some IDUs want their HCV
infection to be treated, many are unwilling or unable to initiate or sustain treatment with currently available
therapies, and IDUs who are treated require considerable, multidimensional support. Solutions to the problem of HCV
infection among IDUs must account for these facts.