Recommendations for the management of hepatitis C virus infection among people who inject drugs

2015 International Journal of Drug Policy In press

Non-invasive liver fibrosis assessment Liver biopsy is the gold standard for liver fibrosis assessment, but is invasive and logistically difficult. As per international guidelines (AASLD/IDSA, 2015; European Association for Study of Liver, 2014), non-invasive methods such as transient elastography or well-established panels of biomarkers of fibrosis are acceptable for liver disease stage assessment.
Non-invasive methods have excellent utility for the identification of HCV-related cirrhosis, but lesser accuracy for earlier stages and can predict HCV-related survival. Combining multiple modalities achieves the best performance.
Non-invasive tests are cost-effective. Among people who inject drugs (PWID), transient elastography can enhance liver disease screening. Recommendations (1) Non-invasive assessments have a reduced risk and greater acceptance than liver biopsy, may enhance HCV screening and disease assessment among PWID, and should be offered, if available (Class I, Level B). (2) Combining multiple non-invasive assessments is recommended, when possible (Class I, Level B).