HEPATITIS IN ALCOHOL AND DRUG MISUSERS - PRACTICAL ISSUES

Viral hepatitis, particularly that due to HBV or HCV, is a significant problem in the UK population of IVDUs and alcohol misusers. Patients attending drug rehabilitation clinics should be screened for HBV and H CV infection. All those found to be HBcAb negative should be vaccinate d against HBV. Those found to be HBsAg or HCV antibody positive should have their liver function tests (LFTs) checked and be referred to a s pecialist liver clinic for further evaluation. Interferon treatment of HBV or HCV infection is effective in a proportion of cases but it is an expensive agent that requires careful monitoring. Current managemen t regimes are centred around the modification of risk behaviour and th e identification of those most in need of, and most likely to respond to, anti-viral treatment. Several new anti-viral agents are currently undergoing clinical evaluation and this together with the prospect of vaccines designed to clear an established infection means that the nex t few years are likely to see some major advances in the treatment of chronic viral hepatitis.