Letter: new treatments for hepatitis C have implications for quality of life in people who inject drugs.

Abstract

Younossi and colleagues' recent review highlighting improvements in the quality of life of people being treated with interferon- and ribavirin-free medications for chronic hepatitis C virus (HCV) is an important contribution to the literature.1 Crucially, the authors note ‘levels of education, income, residence, marital status, social support, the route of HCV transmission, duration of the infection … were not available so could not be adjusted for in their analysis’. One key group of people who are infected with HCV are people who inject drugs (PWID). It is not clear whether people's injecting status has been adjusted for in the analysis of the review. As this is lacking, we believe it is not possible to assess if the benefit of HCV treatment on improved quality of life is present across all groups of people infected with HCV. This includes people who inject drugs who can have a range of other social complexities to their lives.2 Understanding the impact of HCV treatment on quality of life is an important issue for people who inject drugs as it can help us to understand the implications of these other social complexities in people's lives.3 We believe that if there are improvements in the quality of life, then these are important to understand beyond the cure of HCV and the development of significant liver disease. We argue that there is much to learn from people who inject drugs who are a unique population currently absent from much of the data on the effectiveness of interferon free HCV treatment. This can also help in the design and implementation of effective models of care and also ensure that the benefits of the new treatment regimens are maximised for all those who require them. Sometimes I do [feel sick] but then I don't know whether it's the hep C you know what I mean? I don't know the side effects of it or like any problems that other people have with it. (James) The most common examples given in interviews for poor health and lower quality of life could be viewed as a direct consequence of injecting drug use on their lives including: opiate related withdrawal symptoms, mental health issues and stigma.5 Participants acknowledged that HCV may be contributing to their health but rarely described it as the main cause of their current poor quality of life. Accounting for the ongoing stigma associated with injecting drug use is important in truly understanding health related quality of life especially in people living with HCV.6 The development and wider availability of interferon- and ribavirin-free HCV treatment regimens are essential for people who inject drugs currently living with HCV. By systematically collecting data that reveals the changes in quality of life post-treatment in people who continue to inject, we can also develop a clearer understanding of the impact of HCV in their lives. Declaration of personal interests: MH and PH: Research/grant support from Gilead Sciences to the Burnet Institute to support an investigator initiated research study on treatment of PWID. Declaration of funding interests: PH was supported by a Curtin University fellowship. Gilead Sciences provided funding for the project through its Australian Fellowship Research Grants Program. The National Drug Research Institute at Curtin University was supported by funding from the Australian Government under the Substance Misuse Prevention and Service Improvement Grants Fund. MH was supported with a NHMRC Senior Research Fellowship. CW is funded by an Australian Postgraduate Award.