Hepatitis C virus (HCV), which damages the liver, is more prevalent among groups such as prisoners and people with substance abuse and psychiatric disorders. These groups are often denied therapy, despite government mandates to provide it, because they tend to have higher rates of poor compliance with the rigorous antiviral therapy used to treat HCV and higher incidence of psychiatric side effects such as depression, psychosis, and mania. Thus, the risks of therapy tend to outweigh the benefits, considering the substantial costs that range from $10,384 for a 6-month course to $24,168 for a 12-month course of treatment.
Collaboration between gastroenterologists, who manage many HCV patients, and mental health and substance abuse professionals can minimize the adverse psychiatric effects of antiviral therapy and substance abuse relapse and improve adherence to treatment. In a study supported by the Agency for Healthcare Research and Quality (HS15135), University of New Mexico School of Medicine researchers Cynthia M. Geppert, M.D., and Sanjeev Arora, M.D., conclude that such collaboration might make antiviral treatment cost-effective.
After examining five clinical-ethical arguments often given for limiting access of disadvantaged patients to HCV treatment, they recommend a case-by-case approach to ensure appropriate and safe treatment of these groups. They point out that a few small studies have shown that depressed patients who are not psychotic or suicidal, and who are well-controlled on antidepressant medications, are suitable candidates for interferon. Another study showed that many relapsed heroin addicts never missed a clinic appointment for HCV treatment, so substance abuse is not always indicative of noncompliance. The good outcomes cited in the studies were generally the result of collaboration between psychiatrists or addiction specialists and gastroenterologists, which is often not possible in prisons, or in rural or impoverished areas.
See "Ethical issues in the treatment of hepatitis C," by Drs. Geppert and Arora, in the October 2005 Clinical Gastroenterology and Hepatology 3(10), pp. 937-944.