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 HCV infection. All those found to be HBcAb negative should be vaccinated against HBV. Those found to be HBsAg or HCV antibody positive should have their liver function tests (LFTs) checked and be referred to a specialist 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 management regimes are centred around the modification of risk behaviour and the 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 next few years are likely to see some major advances in the treatment of chronic viral hepatitis.