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Journal of Urban Health : Bulletin of the New York Academy of Medicine logoLink to Journal of Urban Health : Bulletin of the New York Academy of Medicine
. 2004 Sep;81(3):428–447. doi: 10.1093/jurban/jth128

Injection drug use and the hepatitis C virus: Considerations for a targeted treatment approach-The case study of Canada

Benedikt Fischer 1,2,✉, Emma Haydon 2, Jürgen Rehm 1,2, Mel Krajden 3,4, Jens Reimer 5
PMCID: PMC3455943  PMID: 15273266

Abstract

Infection with the hepatitis C virus (HCV) is a major public health burden in Canada and globally. The literature shows that injection drug use is currently the primary transmission route for HCV, and that a majority of injection drug users (IDUs) are currently infected with HCV in Canada. This article first reviews the burden of HCV within IDU populations and the transmission risks and the treatment implications speicifc to IDUs. Traditionally, IDUs have been excluded from HCV treatment unless abstaining from illicit drug use. However, recent research suggests that categorical exclusion is not medically necessary. A series of key questions about the feasibility of offering HCV treatment to IDUs in the specific Canadian context are considered, including concerns related to the motivation of treatment for IDUs, treatment delivery, treatment side effects, HCV reinfection, and the social environment. The article concludes that treatment of HCV-infected illicit drug users is both feasible and may be necessary to reduce transmission and adverse outcomes in this high-risk population.

Keywords: Canada, Hepatitis C, Injection drug use, Prevention, Treatment

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