EMCDDA Document library

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

Summary: 

Treatment guidelines are considered to be an important tool in steering patients to medical treatment. This study was conducted to analyze guidelines for the treatment of hepatitis C virus (HCV) infection in injection drug users (IDUs) in the European Union (EU) countries as a component of treatment access. National and international databases, expert contacts, professional societies, and health administrations were approached to acquire guidelines. According to their quality standard, guidelines were divided into expert opinions, semiofficial guidelines, official guidelines, and consensus processes. Recommendations for the treatment of HCV infection in IDUs vary substantially, from lack of recommendations and outright treatment disapproval to recommendations for treatment under specified circumstances. Recent guidelines that apply qualified process procedures that include literature research tend to be more permissive. Qualified guideline processes in each EU country and subsequently renewed pan-European guidelines are needed.

Please see additional information below for the context of this study.

Abstract

This abstract is provided here as a convenience only. Check the publisher's website (if available) for the definitive version.

Treatment guidelines are considered to be an important tool in steering patients to medical treatment. This study was conducted to analyze guidelines for the treatment of hepatitis C virus (HCV) infection in injection drug users (IDUs) in the European Union (EU) countries as a component of treatment access. National and international databases, expert contacts, professional societies, and health administrations were approached to acquire guidelines. According to their quality standard, guidelines were divided into expert opinions, semiofficial guidelines, official guidelines, and consensus processes. Recommendations for the treatment of HCV infection in IDUs vary substantially, from lack of recommendations and outright treatment disapproval to recommendations for treatment under specified circumstances. Recent guidelines that apply qualified process procedures that include literature research tend to be more permissive. Qualified guideline processes in each EU country and subsequently renewed pan-European guidelines are needed.

Additional information: 

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.)