Commentary on Senn et al. (2009): Primary care is the place to manage hepatitis C in opiate-dependent patients

摘要

Screening for a condition which, in its early years, is largely symptomless in a population with many other priorities is always likely to be problematic. Attempts to assess the incidence and prevalence in drug injectors have used a variety of approaches, including opportunistic testing at outreach clinics, prenatal testing, case finding in primary care and in drug treatment clinics and testing of patients with symptoms suggestive of liver disease. The population with by far the highest prevalence of hepatitis C is injecting drug users. Most are young when they become infected and upwards of 50% remain untreated. The expectation of liver cirrhosis and cancer in a percentage may seem a long way off to those infected, and have not yet achieved numbers sufficient to trigger a public heath panic, but the fuse is burning. Dire warnings of the consequences of this pool of disease are frequent and repetitive. Senn and colleagues provide an encouraging offer of a successful model for the first stage of the process of identifying those at risk, diagnosing the presence of the disorder and starting treatment. They show clearly the value of opiate substitute treatment in engaging this risk group and the association of this therapy with a successful outcome in testing. This experience of using the attraction of this treatment to encourage a wider health care agenda is not new, and some feel that it is coercive, but as with other harm reduction measures the end undoubtedly justifies the means.