Barriers to starting and completing hepatitis C treatment

The treatment of hepatitis C, generally with the antiviral agents pegylated interferon and ribavirin, is associated with a significant risk of adverse side effects, such as the suppression of bone marrow production, anaemia, depression and other mood disorders, fatigue and nausea, which lead approximately 14% of recipients to discontinue treatment (Manns et al., 2001). Ribavirin may lead to birth defects, so people contemplating pregnancy often defer treatment (Yee et al., 2006). The most common reason for deciding not to take up hepatitis C treatment or for discontinuing it is that it commonly has psychiatric effects that many find intolerable (see Summary 4). Because treatment generally takes 24 to 48 weeks, people who do not have access to transport, or are transient, homeless and/or engaged in criminal activity may not complete it (Restrepo et al., 2005). In many places treatment is costly and therefore unaffordable for some. As well, there might be insufficient refrigeration facilities for the required storage of interferon.