Contradictory advice for people who inject drugs in the 2016 EASL Recommendations on Treatment of Hepatitis C

The 2016 EASL Recommendations on Treatment of Hepatitis C provide important international guidance for the clinical management of HCV infection. The guidance is crucial in the environment of rapidly changing direct-acting antiviral (DAA) therapeutics. However, there are inherent contradictions within the EASL Recommendations for people who inject drugs (PWID). The EASL Recommendations state that “Treatment should be considered without delay in individuals at risk of transmitting HCV (e.g., active injection drug users)”, given the potential for preventing HCV transmission and reductions in HCV prevalence at a population-level. Such prioritization is consistent with guidelines from AASLD/IDSA, World Health Organization, and International Network for Hepatitis in Substance Users. Yet, the EASL Recommendations present prescriptive and rigid guidance, including that PWID should “accept to undergo integrated management of their substance use, including syringe exchange program, substitution therapy and other general harm reduction strategies” prior to receiving DAA therapy, and that “HCV treatment for PWID should be considered on an individualized basis and delivered within a multidisciplinary team setting.” Although appropriate drug dependency management and multidisciplinary care are important aspects of care provision for PWID, the indication that they are essential is reflective of the interferon-containing era, is restrictive, and non-evidence based.

Visit publication