Below is the letter that was presented to the writers of the NIH HCV Consensus Statement, which was drafted in Bethesda, MD at the 2002 National Institutes of Health Consensus Development Conference on Management of Hepatitis C. Thanks to all of you who signed on to endorse the sentiments of the letter.

Dear 2002 NIH HCV Guidelines Writing Committee:

We, the undersigned community advocates, researchers, public health specialists and clinicians, are writing to recommend a revision of the current NIH HCV Guidelines. The 1997 NIH HCV Guidelines generated by the Management of Hepatitis C National Institutes Of Health Consensus Development Conference stated that "Treatment of patients who are drinking significant amounts of alcohol or who are actively using illicit drugs should be delayed until these habits are discontinued for at least 6 months." We feel that all-encompassing restrictions of HCV antiviral treatment in this patient population are unsupported by scientific data and are unethical. We recommend that the guidelines be revised to state:

    "Treatment of patients who are drinking significant amounts of alcohol or who are actively using illicit drugs should be left to the discretion of the provider and patient and decided on a case-by-case basis."

Injection-related HCV has become the dominant route for HCV infection in the United States and drug users will become the primary population seeking medical care for this condition in the near future. Drug users are a stigmatized population whose lives are frequently adversely affected by society’s moral views about their drug use. Nevertheless, morality cannot dictate healthcare as there are many individuals with a history of drug use who are capable of assessing the pros and cons of treatment and with whom a comprehensive treatment plan can be devised.

Epidemologic, natural history and behavioral research data in past and present HCV-infected drug users are scant. We recommend that the NIH, with its multi-million dollar hepatitis research budget spread over numerous institutes, including NIDDK, NIAID, NCI, NIDA and NIAAA, dedicate funds to support innovative and quality research in this patient population. Moreover, the NIH should support research on comprehensive, multidisciplinary treatment approaches that incorporate hepatologists, infectious disease specialists, mental health practitioners and substance use counselors. The Veterans Administration is to be applauded for taking the lead in funding pilot sites engaged in multidisciplinary HCV models of care. The NIH must follow suit.

As we search for truly viable medical treatments, individuals with a history of drug use cannot be categorically excluded from clinical trials or any part of the research agenda. On-going research must reflect the urgent needs of those drug-using individuals who are multiply diagnosed with HCV, HIV, and mental health issues. True partnerships between health officials, clinicians, researchers, primary care physicians, drug users and their advocates are urgently needed.

Sincerely,

Allan Clear
Executive Director
Harm Reduction Coalition
New York, NY

Michael Marco
New York, NY
Jason Farrell
Positive Health Project
New York, NY
A, B, C, D-E, F, G, H-I, J-K, L, M, N-O, P, R, S, T-V, W-Z
Sara Amber
Hepatitis Education Project
Seattle, WA

Janet Adams, Ph.D.
Family Health Council, Inc.

Lois Ahrens, Director
The Real Cost of Prisons Project
An Activity of the Sentencing Project
Washington, DC

AIDS Action
Washington, DC

E.Russell Alexander MD
Professor Emeritus of Epidemiology
University of Washington
Vice President
Hepatitis Education Project
Seattle WA

Bruce Anderson
New York, NY

Stephen Arrendell
New York, NY

Sameena Azhar
Young Men's Study, Center for AIDS Prevention Studies, UCSF,
San Francisco, CA

Dan Babuscio
Prevention Point Pittsburgh
Pittsburgh, PA

Markus Backmund, MD
Hospital Munich Schwabing
Addiction Medicine
München, Germany

David Bangsberg, MD, MPH
Assistant Professor in Residence
Director of the Epidemiology and Prevention Interventions Center
San Francisco General Hospital, UCSF
San Francisco, CA

Paola Barahona
Executive Director
PreventionWorks
Washington, DC

Steven L. Batki, M.D.
Professor and Director of Research
Department of Psychiatry
SUNY Upstate Medical University
Syracuse, NY

Phyllis Beck
National Hepatitis C Prison Coalition
& Hepatitis C Awareness Project
Eugene, OR

Christopher Brown
Assistant Commissioner
Chicago Department of Public Health
Chicago, Illinois

Alice Bell, LSW
Coordinator
Prevention Point Pittsburgh
Pittsburgh, PA

Mona Bennett
Program Director
Atlanta Harm Reduction Center

Dan Bigg, CRADC
Chicago Recovery Alliance
Chicago, IL

James Bolas
Empire State Coalition of Youth & Family Services
New York, NY

Joseph Bostic
NYC AIDS Housing Network
Brooklyn, NY

Ronald Bosch
Chair
Franklin County Hepatitis C Project
Great Falls, MA

Mary Brett, MSW
Social Work Case Manager
Peter Claver Community
San Francisco, CA

Sabira Bushra, Director
Partnership for Minority HIV/AIDS Prevention
Pittsburgh, PA

Jude Byrne
Australian IV League

Corrine Carey
Urban Justice Center,
New York, NY

Mark Casanova
Homeless Health Care Los Angeles
Los Angeles, CA

Lei Chou
The Access Project
AIDS Treatment Data Network
New York, NY

Luciano Colonna
Harm Reduction Project
Salt Lake City, UT

Denise Connally PHN
Vermont Dept. of Health
Barre, VT

Amy Cortney
Advocates for Recovery through Medicine New Jersey Chapter Director
Addiction Treatment Watchdog-Opinions Editor

Critical Path AIDS Project

Prof Nick Crofts
Deputy Director
The Macfarlane Burnet Institute
for Medical Research and Public Health
Victoria, Australia

James W. Curran, MD, MPH
The Rollins School of Public Health
Emory University
Atlanta, GA

Sue Currie, MA
Hepatitis C in the California Prisons Project
Department of Medicine, UCSF
San Francisco, CA

Ric Curtis, Chair
Department of Anthropology
John Jay College of Criminal Justice
New York, NY

Julie Davids
Philadelphia, PA

Annet Davis-Vogel, RN, MSW
Philadelphia, PA

Dawn Day, Ph.D.
Director, Dogwood Center
Princeton, NJ

Don Des Jarlais, Ph.D.
Director of Research
Baron Edmond de Rothschild Chemical Dependency Institute
Beth Israel Medical Center
New York, NY

Charlotte Dick
HIV Prevention Project
San Francisco AIDS Foundation
San Francisco, CA

Andrew Epstein
Students for Sensible Drug Policy
New York, NY

Martha A. Epstein
Project Director
Bronx Treatment Court
Bronx, NY

David Ewell
Executive Director
San Antonio AIDS Foundation
San Antonio, TX

Annie Fahy BSN, CACII
Recovery Café
Athens, GA

Judith Farrer
Justice Resource Institute's Assisted Living Programme
Boston, MA

Robert J. Feikema
Executive Director
Pittsburgh AIDS Task Force
Pittsburgh, PA

Sara Jane Firth
HIV/STD Counselor
St. James Infirmary
Occupational Health and Safety Clinic
San Francisco, CA

Tracy Fischman, Director of Policy and Legislative Affairs
Chicago Department of Public Health
Division of STD/HIV/AIDS Public Policy and Programs
Chicago, IL

Peter Fisher, BS (Public Health)
Co-chair: Franklin County (MA) Hepatitis C Action Project
Great Falls, MA

Heather Fitch
Redwood City, CA

Tiffany Fitzpatrick
Prevention Point Pittsburgh
Pittsburgh, PA

Patsy Fleming
President, Prevention Works:
Needle Exchange in the Nation's Capitol
Washington, DC

Ken Fornataro
Executive Director
AIDS Treatment Data Network
New York, NY

Susan Forrest
HIV Resource Specialist
BHS-CASC
Los Angeles, CA

Leslie Franz
Hepatitis Education Project
Seattle, WA

Gerald Friedland MD
AIDS Program
Yale School of Medicine
Yale New Haven Hospital
New Haven, CT

Sam Friedman
National Development and Research Institutes
New York, NY

John Fung, MD, PhD
Thomas Starzl Professor of Surgery
Chief, Division of Transplant Surgery
University of Pittsburgh, PA
Elana Galante
Harm Reduction Counselor/Agency Trainer
Central City Hospitality House
San Francisco, CA

Deborah Jane Gausmann, RN
Presbyterian AIDS Network
Pittsburgh, PA

Anthony Gichemi
Outreach Coordinator
HIV/AIDS Services Inc.
Grand Rapids, MI

James J. Goedert, M.D.
Viral Epidemiology Branch
National Cancer Institute, NIH

Lorna Gottesman
Harlem Director's Group
New York, NY

Jenna Grant
Hepatitis Testing, Education and Vaccination Project
Berkeley Free Clinic
Berkeley, CA

Howard Grossman, M.D.
New York, NY

Donald Grove
Moving Equipment
New York, NY

Mauro Guarinieri
EATG vice-chair
Milan, Italy

Frank Guzman, Director
Harm Reduction Cultural Resources
Minneapolis, MN

Laura C. Guzman
Director, Mission Neighborhood Resource Center
San Francisco, CA Christopher Hall, MD
University of California San Francisco
San Francisco, CA

Judy Hahn, Ph.D.
UCSF
San Francisco, CA

Jon Paul Hammond
Reasearch Associate
Urban Health Study, UCSF
San Francisco, CA

Kim Hardin
Prevention Point Pittsburgh
Pittsburgh, PA

Robert Heimer
Dept. Epidemiology and Public Health
Yale School of Medicine
New Haven, CT

Daliah Heller
CitiWide Harm Reduction
Bronx, NY

Martin S. Hirsch, MD
Harvard Medical School
Boston, MA

Francois Houyez
European Aids Treatment Group
Paris, France

Emalie Huriaux
Street Outreach Worker MPH Student
Women's Community Clinic
San Jose State University
San Jose, CA

Ron Jackson, MSW
Evergreen Treatment Services
Seattle, WA

Hermione Jefferis
Co-ordinator, Hepatitis C Project
Street Outreach Services, AIDS Vancouver Island
Victoria, BC, Canada

Nancy E. Jones, President,
Nancy Jones Enterprises
New York, NY

Howard Josepher, CSW
Executive Director
Exponents
New York, NY

Marie Keem
Senior Research Associate
National Development and Research Institutes, Inc
New York, NY

Mark Kinzly
Yale School of Public Health
New Haven, CT

Michael Kluger, MPH
Project Director, The Hepatitis Project
New York University School of Medicine
New York, NY

Ana Kosok, Program Director
Moderation Management Network Inc.
New York, NY

Drew D. Kramer
Executive Director
Lower East Side Harm Reduction Center
New York, NY

Joey Kue
community activist
Lynne LaFontaine
Austin Harm Reduction Coalition
Austin, Texas

Carl A. Latkin, Ph.D.
Associate Professor
Faculty of Social and Behavioral Sciences
Department of Health Policy and Management
Johns Hopkins School of Public Health
Baltimore, MD

Carin V. Layne-Lomon
HIV/AIDS/HCV Advocate-Educator
Boston, MA

James Learned
Hepatitis C Action & Advocacy Coalition (HAAC)
New York, NY

Danni Lentine, M.P.H.
Acting Executive Director
Atlanta Harm Reduction Center

Jules Levin, Executive Director
National AIDS Treatment Advocacy Project
New York, NY

Logan Lewis
Phoenix Housex
New York, NY

Sage Loats
Oakland, CA

Mollie Lowery
Lamp Community
Los Angeles, CA

Paula J. Lum, MD MPH
Assistant Adjunct Professor
Positive Health Program, Department of Medicine
San Francisco General Hospital
University of California
San Francisco, CA

Kathie Lustig
Executive Director
"Back to Life"-Santa Barbara
Hepatitis C Support Project
Santa Barbara, CA

Bob Madison
American Liver Foundation
New York, NY

Rosylen M. Mangohig, Esq.
Berkeley, CA

G. Alan Marlatt, Ph.D.
Professor and Director
Addictive Behaviors Research Center
University of Washington
Dept. of Psychology
Seattle, WA

Terri Martinez, Director
Addiction Treatment Watchdog

William D. McColl
Director of National Affairs,
Drug Policy Alliance
Washington, DC

Kate McCoy, Ph.D.
Project Coordinator
Montefiore Medical Center
Department of Family Medicine and Community Health
Bronx, NY

Rachel McLean
The DOPE (Drug Overdose Prevention & Education) Project
San Francisco, CA

Andrea Miller
Research Associate
Hampden County Correctional Center
Dept. of Epidemiology and Biostatistics
University of Massachusetts - Amherst

Maureen Miller, PhD
Columbia University
New York, NY

Ellen Miller-Mack
Brightwood Health Center
Springfield, MA

Randy Milne (Co-Chair)
Consumer Advisory Board of the Southwestern PA AIDS Planning Coalition
Pittsburgh, PA

Lisa Moore
Assistant Professor, Department of Health Education
San Francisco State University
San Francisco, CA

Brian Murphy
Highlands Community Development Corporation
West Milford, New Jersey

Bill Nelles General Secretary
Dr. Chris Ford Chair
The Methadone Alliance
London, UK

Anna Nelson, Executive Director
Interior AIDS Association
Fairbanks, AK

Michael Ninburg
Executive Director
Hepatitis Education Project
Seattle, WA

Bob Norman
Program Manager
Access Works
Minneapolis, MN

Kris Nyrop
Street Outreach Services
Seattle, WA

Kevin P. Nuttall
North Catolina AIDS Policy Center

Alyshia Ogdie
Oakland, CA

Heidi Olson, Prevention Specialist
AIDS Network/Networks
Madison, WI

Katie O'Neill
Sr. VP for Law and HIV/AIDS Projects Director
Legal Action Center
New York, NY
Ane Kunga Palmo
DOC Religious Advisory Committee
Hepatitis C Advocate
Seattle, WA

Denise Paone Ed D
New York, NY

Larry David Pasco
Founder & Executive Director
Harm Reduction Institute ( The Aids Brigade )

Max Pepper, MD, MPH
Adjunct Professor of Public Health
University of Massachusetts School of
Public Health at Amherst, MA

Philadelphia FIGHT

Tom Price
St. Louis, MO

Divine Pryor
ADAPT
Brooklyn, NY

Dave Purchase
North American Syringe Exchange Network
Tacoma, WA

James Reinke
LifePoint Program
AIDS Resource Center of Wisconsin
Madison, WI

Josiah D. Rich, M.D., M.P.H.
Associate Professor of Medicine and Community Health
Brown University School of Medicine
Attending Physician, The Miriam Hospital
Providence, RI

Jill Rips
Assistant Director
San Antonio AIDS Foundation
San Antonio, TX

Helen Redmond MSW LCSW
University of Illinois at Chicago
Family Center for Immune Defiency and Immunology
Chicago, IL

Christy Robb
Shelter & Food for the Homeless
New York, NY

Andre Robertson
Director of Prevention
Black Coalition on AIDS
San Francisco, CA

J. Giselle Rogers
Public Health Nurse
Interior Health Authority
Kootenay Boundary Community Health Services
Castlegar, B. C. Canada

Gary Rose
Title II Community AIDS National Network

Allan Rosenfield, MD
Dean, Mailman School of Public Health
Columbia University
New York, NY
(personal endorsement, name of School for identification purposes only)

Leana Rosetti
Volunteer Coordinator
HIV Prevention Project,
San Francisco AIDS Foundation
San Francisco, CA

Renee Ross
New York AIDS Coalition
New York, NY

Debra Rothschild, Ph.D.
Private Practice
New York, NY

Matt Rowe
Haight Ashbury Youth Outreach Team
San Francisco, CA

Maureen Rule, MA, LPC
Albuquerque, NM

Romeo Sanchez
Alliance for Inmates with AIDS
New York, NY

Lynne A. Sampson, MPH
Doctoral Student
Department of Epidemiology
University of North Carolina, Chapel Hill
Chapel Hill, NC

Wayne Saville, M.D.
Assistant Professor
UCSD School of Medicine
San Diego, CA

Jeffrey Schouten, MD
Seattle Treatment Education Project
Seattle, WA

Charles A. Sessoms
Director of Prevention and Education
AIDS Support Group of Cape Cod
Provincetown, MA

Kimberly Page Shafer, Ph.D., M.P.H.
Assistant Professor
Dept. of Medicine, Center for AIDS Prevention Studies
University of California San Francisco
San Francisco, CA

Susan G. Sherman, PhD, MPH
Johns Hopkins University Bloomberg School of Public Health
Baltimore, MD

Mike Shriver
Advisor to the Mayor on AIDS & HIV Policy
Co-director
AIDS Policy Research Center
AIDS Research Institute/UCSF
San Francisco, CA

Randy Silva, Case Manager II
Episcopal Community Services- The Rose
San Francisco, CA

Sue Simon,
New York, NY

Paul Simons
Executive Director
Sensory Park
Denver, CO

Peter Simpson, Executive Director
Harm Reduction Services
Sacramento, CA

Suzette Smetka, Executive Director
Community Health Outreach Project Hawaii
Honolulu, HI

Bryan C. Cole Smith, M.Ed.
University of Pennsylvania School of Dental Medicine
Hospital of the University of Pennsylvania's Infectious Disease Clinic
Adult AIDS Clinical Trials Group Community Constituency Group

Jo L. Sotheran, Ph D
Mailman School of Public Health, Columbia University
New York, NY

Freya Spielberg, MD, MPH
Assistant Professor, University of
Washington, Seattle, WA

Sharon Stancliff, MD
Medical Director
Harlem East Life Plan
New York, NY

P. Clay Stephens
School of Public Health - SUNY-Albany
(Affiliation for identification purposes only)

Jim Stodola, Director of Services
AIDS Network/Networks
Madison, WI

Steffanie Strathdee Ph.D.
Department of Epidemiology
Johns Hopkins Bloomberg School of Public Health
Baltimore, MD

Dan Sundquist
Harm Reduction Alliance, NH

Tracy Swan
AIDS Treatment Activists Coalition
New York, NY

Reena Szczepanski
Hepatitis Prevention Program
New Mexico Department of Health
Albuquerque, NM

Bob Thawley
Urban Health Study
UCSF
San Francisco, CA

Kevin Tillman
Duke University
AIDS Community Advisory Board

Andi Thomas
Executive Director
Hep-C ALERT, Inc.
North Miami, FL

Rick C. Thornton
Novato, CA

Don Topping
Drug Policy Foundation of Hawaii
Honolulu, HI

Kenneth A. Vail, M.P.H., M.A.
Director, HIV Outreach, Prevention & Education Department
AIDS Resources, Information & Services (ARIS) of Santa Clara County
San Jose, CA

Leatrice Wactor
Harlem Director's Group
New York, NY

Chia Wang, MD, MS
Medical Co-director, Hepatitis & Liver Clinic
Harborview Medical Center
Seattle, WA

Judith N. Wasserheit, M.D., M.P.H.
Director, HIV Vaccine Trials Network
Member, Fred Hutchinson Cancer Research Center
Professor of Medicine, University of Washington
Seattle, WA

Monique Whalen
The Works Needle Exchange
Boulder, Colorado

John D. Whitfield III
HR-SEP Coordinator
Outside In
Portland, OR

Peter Whiticar, Branch Chief
STD/HIV AIDS Prevention
Hawaii Department of Health
Honolulu, HI
Yana Wirengard
San Francisco AIDS Foundation/HIV Prevention Project
San Francisco, CA

Dr. Bob Wood
Director, HIV/AIDS Program
Public Health - Seattle & King County
Assoc. Prof. of Medicine/Public Health
University of Washington
Seattle, WA

Rebecca M. Young, Ph.D.
NDRI, Inc.
New York, NY

Barry Zevin MD
Medical Director
Tom Waddell Health Center
San Francisco Department of Public Health
San Francisco, CA

Susan Ziony
Board President
Atlanta Harm Reduction Center