514 Higgs P et al. would be required to specifically address this issue (5). A recent review on HCV treatment for PWID in patient groups with and without a history of injecting drug use showed that the group with a history of injecting drug use was able to successfully complete treatment with minor variations in treatment outcomes (6). Presently, a number of international research studies conducted in different treatment settings show that it is possible to successfully provide HCV treatment to current injectors (7-10). Previous research has shown that there are individual (both the patient and provider) and structural barriers to HCV treatment (11-13). During a previous literature review on hepatitis C antiviral treatment in PWID, we identified 3 barriers that may on an individual level, affect the treatment in injecting drug users and were commonly cited as the formal exclusion criteria for, or predictors of exclusion from, the antiviral therapy: continued injecting drug use, alcohol use, and pre-existing mental disorders (11, 14-21). 2. Objectives Although we observed that individual barriers were not the only ones that prevented injecting drug users from accessing treatment, we limited our review on this to focus more on the above-mentioned 3 barriers. For each barrier, we delineated a myth that underlay the exclusion of affected HCV-positive patients from receiving treatment. In the context of our study, a myth was defined as a commonly held belief that may or may not have been consistent with the available evidence. 3. Materials and Methods A literature review was undertaken on the effects of alcohol consumption, mental disorder, and current injecting drug use on hepatitis C antiviral treatment to evaluate the extent to which the 3 myths were evidence- based. The literature searches were conducted from 2008 to July 2010. By using Ovid MEDLINE®, we searched the entries in the database from 1996 to the present with daily update, and keyword mapping identified the following subject headings to be used as search terms: “hepatitis C”, “hepacvirus”, “antiviral agents”, “alcohol- related disorders”, “alcohol drinking”, “mood disorders”, and “substance use, intravenous”. Various combinations and sub-categories of the above subject headings were used in the searchers. We also used the “explode” function in Medline, which allows broad searching of a term while simultaneously narrowing the searches for all other terms in the subject heading. Reference lists in the identified articles were also searched for obtaining any relevant information. We included articles in English that described results from original research or meta-analyses that measure the outcomes of continuous alcohol consumption, a pre-existing mental illness, and/or current injecting drug use in patients receiving hepatitis C antiviral therapy, or articles that Intravenous drug users and hepatitis C treatment reported a successful follow-up for measuring the rates of reinfection of patients who received antiviral therapy. 4. Results Over 400 articles were filtered through the database searches, and 66 were included in this review. In the next section of the paper, we include a critical review of the 3 myths identified. 4.1. Myth 1: Illicit use of drugs during HCV treatment may cause complications and increase the chance of reinfection Few studies, all with small samples (N < 75), have investigated the impact that current injecting drug use during HCV treatment has on the rates of sustained virological response (SVR). Four studies have found similar SVR rates among participants who reported injecting drug during the treatment period and those who had a history of injecting use but had reported no drug use during the treatment (8, 10, 22, 23). Participants of 2 studies who injected regularly (at least once in every 2 days for a prolonged period during the treatment) were observed to have lower SVR rates than those who abstained from injecting or injected less frequently during the treatment, even though the differences did not reach a statistically significant value (22, 23). Several studies have found that those who continued injecting drug use during treatment were less likely to comply with the treatment regimen and hence did not complete treatment (24, 25). However, 2 other studies showed that frequent injecting drug use during treatment did not affect the probability of attaining an SVR as long as the treatment regimen was completed (8, 26). Few studies have conducted a systematic follow-up of the participants after HCV treatment, and those studies have shown low rates of reinfection (27). Although there are cases of posttreatment reinfection in the literature (28-30), the incidence of such cases is less frequent than the incidence of HCV infection (31) or reinfection (32, 33) in community-based studies. 4.1.1. Implications Adherence to treatment appears to be a stronger predictor of whether injectors with chronic HCV infection will achieve SVR than whether or at what levels they inject drugs during the treatment period. The less clear part is how the complex social and environmental factors can be managed so that individuals could have strategies that can help ensure adherence to the treatment regimen. This includes management of side effects that may occur during treatment. Although follow-up after treatment to measure the reinfection rates have been done in a lesser number of participants, to date the reinfection rates that have been observed after treatment are far lower than those observed after spontaneous clearance. Therefore, Hepat Mon. 2011;11(7):513-518