9261 HEPATITIS C REPORT GALLEY - North West Public Health ...

A course of treatment usually comprises injections of interferon alpha three times a
week for a year. This treatment successfully clears the virus in only 20% of cases
(Liang et al. 2000), with some individuals simply not responding and some relapsing
after treatment finishes. Failed treatment may increase the severity of the eventual liver
disease (Dusheiko et al. 1996). However, the latest treatment, combination therapy
with interferon and ribavirin, increases the success rate to 40% (Liang et al. 2000).
Combination therapy is expensive, at around £6,000 per patient (but the cost of this
may be considerably less than the social and medical costs of letting the disease
progress untreated: Leal et al. 1999). Treatment is associated with unpleasant side
effects such as nausea and depression and requires a high level of compliance
(Liang et al. 2000). In contrast, the behavioural characteristics of IDUs can be chaotic
and consequently the demands of the treatment regime have been considered by
some to make it unsuitable for this group of patients (Renton & Main 1996).
Furthermore, since the risk of re-infection is high (immunity is not obtained even if the
infection is cleared from the body: Liang et al. 2000), it is generally only recommended
for individuals who are definitely drug free.
Although there is no evidence that continued drug use increases progression to severe
liver disease, alcohol use and co-infection with other viral infections such as HIV and
hepatitis B do appear to increase the risk of serious disease (Pol et al. 1998; Tagger et
al. 1999; Allory et al. 2000). Conversely, hepatitis C infection appears not to accelerate
the course of HIV disease (Haydon et al. 1998; Staples et al. 1999), although this may
depend on the genotype of the hepatitis C virus (Dieterich 1999). The management of
treatment in cases of co-infection with HIV is complex (Dusheiko et al. 1996) and there
is an increased risk of transmission of hepatitis C from mother to child (Resti 1999).
H EPATITIS C IN INJECTING DRUG USERS IN THE N ORTH W EST
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