Guidelines for the treatment of hepatitis C virus infection in injection drug users: status quo in the European Union countries.

This study was funded through an EMCDDA contract (CT.2003.104.P2).

In 2003, the EMCDDA launched a consultant study to determine if treatment guidelines in use across 15 EU countries and Norway limit or promote the access of injecting drug users to treatment for liver disease. The four specific objectives of this study were: 

• To identify and compile official and semi-official guidelines for the treatment of hepatitis C infection in drug users that are in use in EU Member States and Norway; 
• To compare the guidelines and identify similarities, differences, and consistency with the state of research;
• To critically assess their potential with regard to enabling access to treatment of hepatitis C infection in drug users, especially active drug users and those that are HIV co-infected;
• To identify possible needs with regard to increased treatment access.

The consultant expert group (http://www.zis-hamburg.de/index.en.html) established contact with the National Reitox focal points, professional societies and experts throughout Europe and gathered treatment consensus statements, official and semi-official guidelines as well as expert opinions. Several quality and contents aspects of the treatment recommendations were appraised, applying a standardised qualitative evaluation tool for the assessment of the guidance.. The analysis includes an assessment of scientific rigour and evidence base, clarity and applicability of the treatment guidelines and as well as of their editorial independence. 

The study, completed in 2004, showed that recommendations for the treatment of HCV in IDUs vary substantially, from a lack of recommendations and outright treatment disapproval to recommendations for treatment under specified circumstances. Recent guidelines that apply qualified process procedures and include literature research tend to be more permissive (see also Reimer J et al. (2005) Guidelines for the treatment of hepatitis C virus infection in injection drug users: status quo in the European Union countries. Clin Infect Dis., Vol 40 (15 April), Supplement 5, S 373-378.)