Treatment of Hepatitis C Virus in Special Populations (HBV Coinfection, Drug Users, and Prisoners)

  • Dalbir S. Sandhu
  • Randhir JesudossEmail author


Hepatitis B virus (HBV) and hepatitis C virus (HCV) share the pathways of transmission and, consequently, dual-HBV/HCV infection is frequently observed in geographical areas where both infections have an intermediate or a high endemicity level and in special populations at high risk of acquiring both infections. Patients with dual-HBV/HCV infection more frequently develop liver cirrhosis and hepatocellular carcinoma (HCC) than those with a single infection. In vitro, morphologic and clinical investigations have shown the reciprocal inhibition of HBV and HCV genomes. The treatment of hepatitis C in these special populations is complex and decision is made on the stage of liver disease, virus predominance, and presence of human immunodeficiency virus (HIV) infection and comorbidities. Treatment with PEG-IFN and ribavirin for HCV eradication has been replaced by a combination of two or more directly acting antivirals (DAAs) of different classes with DAA regimens becoming the therapy of choice in HCV and hence in HBV/HCV dual infection with sustained virological response (SVR)12 rates in the 95% range. Tenofovir or entecavir must be integrated with DAA treatment in patients with both HCV and HBV in a chronic active phase, in those with cirrhosis, and in those coinfected with HIV. Treatment of hepatitis C in IV drug users (IVDU) and prisoners is best served in a multidisciplinary setting. Comparable rates of adherence and reinfection are found in IVDU compared to nondrug users. DAAs in combination with programs such as needle syringe program and opiate substitution therapy will help treat hepatitis C in IVDU and prevent transmission.


Hepatitis C Hepatitis B Intravenous drug users Prisoners 


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Gastroenterology and HepatologyCase Western Reserve University/MetroHealth Medical CenterClevelandUSA
  2. 2.Case Western Reserve UniversityClevelandUSA
  3. 3.Internal Medicine/Gastroenterology and HepatologyUniversity of Iowa Hospital and ClinicsIowa CityUSA

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