8 top stories on injection drug users, HIV/HCV coinfection

At the recent International Symposium on Hepatitis Care in Substance Users, researchers presented new data on injection drug users and their unique risk factors for hepatitis C infection and transmission, including younger age, and the critical need for HCV education among addiction clinic workers.

Additionally, recent news focused on the efficacy of HCV treatment in HIV/HCV coinfection, the barriers to treatment that patients with HIV/HCV face, and the fact that patients with HIV/HCV coinfection remain marginalized despite progress in screening and therapy.

Among injection drug users, young adults at highest risk for HCV

Adult injection drug users aged 30 years or younger are at the highest risk for both acquiring hepatitis C and transmitting HCV, according to a presentation at the International Symposium on Hepatitis Care in Substance Users.

“Given the high incidence of HCV in younger injectors and evidence that risk is increased if they are injecting with younger people — and that knowledge of injecting partners’ serostatus may also impact risk — there is a need for two critical things,” Kimberly Page, PhD, MPH, MS, from the University of New Mexico Health Sciences Center, told Healio.com/Hepatology. “First, rapid testing that includes HCV RNA results to increase knowledge of viral status; and second, interventions to increase disclosure of HCV viral status among young injectors.” Read more

Injection drug users with HCV lack awareness of DAA efficacy

Most people who inject drugs were not aware of currently available, highly effective hepatitis C treatments, according results of a national survey in Scotland presented at the International Symposium on Hepatitis Care in Substance Users.

From 2015 to 2016, researchers surveyed 2,623 individuals who attended injection equipment provision sites to assess the awareness of new direct-acting antivirals and their efficacy among injection drug users and to determine the factors associated with awareness. Read more

Addiction clinics need physician education, lifted restrictions to treat HCV

Opioid agonist therapy clinics represent an important conduit for people who inject drugs to receive information, screening and treatment for hepatitis C. Within these clinics, however, physicians and addiction specialists self-reported low competence regarding current HCV treatments. Additionally, policies that restrict treatment for current and recent drug users present an ongoing barrier.

“From a public health perspective, when you treat patients who are actively using, this is the population you need to treat if you want to achieve the WHO goals of elimination by 2030,” Alain H. Litwin, MD, professor of medicine and psychiatry at Albert Einstein College of Medicine, told Healio.com/Hepatology. “By treating people who are actively using, you can reduce the community viral load. For new patients who are uninfected or those who have been treated successfully, they will be less likely to be infected or reinfected. If you don’t treat the active users, we will never achieve the goal of elimination.” Read more

HCV treatment cures patients despite injection drug use

Patients who were treated for hepatitis C virus infection through an opiate addiction program overwhelmingly achieved SVR even though many of them injected drugs, according to researchers.

The results counter widely entrenched policies in the United States denying HCV treatment coverage to those who inject drugs on the presumption that they will not adhere to therapy. Studies have shown that injection drug use has driven the current HCV epidemic. Read more

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Increased coffee consumption lowers mortality risk in HIV/HCV coinfection

Elevated coffee consumption of three or more cups per day halved the all-cause mortality rate among patients with hepatitis C and HIV coinfection, according to a recently published study.

“Polyphenols and caffeine in coffee have several hepatoprotective properties. In people at risk of liver disease, previous research has shown that coffee consumption is associated with better liver function, and less fibrosis, cirrhosis and liver cancer,” Maria Patrizia Carrieri, PhD, from the Aix-Marseille Université, France, and colleagues wrote. “In patients coinfected with HIV/HCV, individuals with elevated coffee consumption (defined as drinking three cups or more per day) have a reduced risk of insulin resistance and lower levels of liver enzymes.” Read more

HCV therapy low among HIV/HCV patients with alcohol dependence

Alcohol dependence presents a significant barrier to hepatitis C treatment among patients with HIV compared with non-alcohol substance dependence, according to a presentation at the International Symposium on Hepatitis Care in Substance Users.

According to the presentation by Kyle W. Prochno, a research coordinator from the Icahn School of Medicine at Mount Sinai, New York, alcohol-specific dependence was particularly prohibitive to HCV treatment initiation among patients with HIV, even when applying a treatment initiation-promoting intervention. Read more

HIV/HCV Coinfection Remains Marginalized Despite Progress

The population of patients coinfected with HIV and hepatitis C in the U.S. remains largely marginalized for one reason or another. They are opioid drug users, Medicaid recipients, men who have sex with men; often, they are all the above. The fact that there are medications in the marketplace that can control or cure their dual infections makes their predicament even more frustrating. These are people who, clinically speaking, should be leading normal, healthy lives. Yet they are not.

Lianping Ti, PhD, a research scientist with the Epidemiology and Population Health program at the BC Centre for Excellence in HIV/AIDS and assistant professor in the Department of Medicine at the University of British Columbia, has focused largely on addiction. “You can’t understate that the over-prescription of opioids for pain has been a huge issue,” she said. “Trying to address the comorbid conditions of HIV, HCV and illicit drug use presents a host of challenges.” Read more

Light alcohol use does not accelerate fibrosis in women with HCV/HIV coinfection

Light alcohol consumption did not influence liver fibrosis in women who were coinfected with HIV and hepatitis C virus, according to recently published findings in Clinical Infectious Diseases.

“HIV/HCV coinfected patients have accelerated fibrosis progression as compared to HCV mono-infected individuals,” Erin Kelly, MD, assistant professor of the Ottawa Hospital, and colleagues wrote. “Whether regular consumption of small quantities of alcohol further increase the rate of fibrosis progression is unknown.” Read more