Hepat Mon. 2011;11(7):513-518 KOWSAR Journal home page: www.HepatMon.com Barriers to receiving hepatitis C treatment for people who inject drugs: Myths and evidence Peter Higgs 1, 2, 3* , Rachel Sacks-Davis 2, 3, Judy Gold 2, 3 , Margaret Hellard 2, 3 1 National Center in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia 2 Center for Population Health, Burnet Institute, Melbourne, Australia 3 School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia A R T I C L E I N F O Article Type: Review Article Article history: Received: 25 Aug 2010 Revised: 18 Feb 2011 Accepted: 06 Apr 2011 Keywords: Hepatitis C virus Interferon Drug users Alcohol Mental disorder A B S T R A C T Background: Alcohol consumption, current injecting drug use, and pre-existing men- tal illness have been identified as 3 of the main reasons for excluding patients from treatment for hepatitis C. Objectives: We reviewed the literature to obtain an evidence base for these common exclusion criteria. Materials and Methods: We reviewed original research and meta-analyses investigating the effects of alcohol consumption, current injecting drug use, and pre-existing men- tal illness. Results: We identified 66 study reports relevant to the review, but found only limited evidence to support withholding of treatment on the basis of the 3 previously men- tioned exclusion criteria. Conclusions: Currently, there is a lack of evidence for many of the barriers faced by pa- tients in availing treatment for hepatitis C. Adherence to treatment routine was found to be a better predictor of sustained virological response than injecting drug or alco- hol consumption during treatment period or the presence of a pre-existing mental disorder. Although several challenges remain, we need to ensure that treatment deci- sions are based on the best available evidence and the treatment is performed appro- priately on a case-by-case basis. c 2011 Kowsar M.P.Co. All rights reserved. Implication for health policy/practice/research/medical education: Making evidence-based HCV treatment decisions rather than ones based on preconceived ideas about people who deserve treatment for HCV is essential. Those involved in deciding to offer HCV treatment would do well to consider the results of this study which show that patient centred treatment is crucial. Please cite this paper as: Higgs P, Sacks-Davis R, Gold J, Hellard M. Barriers to recivieng hepatitis C treatment for people who inject drugs: Myths and evidence. Hepat Mon. 2011;11(7):513-8. 1. Background In developed countries, people who inject drugs (PWID) are at the greatest risk of infection with hepatitis C virus (HCV) (1, 2). Despite the lack of evidence, throughout the 1990s, regulations restricting PWIDs’ access to referral * Corresponding author at: Peter Higgs, National Center in HIV Epidemiol- ogy and Clinical Research, University of New South Wales, Sydney, Australia. Tel: +61-392822195, Fax: +61-392822100. E-mail: p.higgs@unsw.edu.au Copyright c 2011, BRCGL, Published by Kowsar M.P.Co. All rights reserved. for specialist treatment for their chronic HCV infection has existed in a number of western countries (3, 4). The 2005 special issue (40, supplement 5) of Clinical Infectious Diseases was dedicated to HCV infection, managing opiate dependence, and developing models of integrated care for HCV-positive people. The summary in the special issue concluded that there remained important knowledge gaps on the providing the best health-care and treatment for HCV infection in current injecting drug users and stated that further research