HCV treatment ‘an opportunity’ to screen for substance use, mental health disorders
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Another study has highlighted the potential for physicians to concurrently treat certain infections and substance use disorders.
Researchers found that, among patients with HIV who were newly engaged in care for hepatitis C virus infection and who recently used cocaine or heroin, nearly one in five also had hazardous levels of alcohol use and symptoms of depression, according to a study published in Open Forum Infectious Diseases.
“We know that patients who use illicit drugs such as heroin and cocaine often use other substances such as alcohol and may have coexisting mental health disorder. This substance use increases risk of HIV and hepatitis C virus (HCV) infection,” Oluwaseun Falade-Nwulia, MBBS, MPH, associate professor of medicine in the division of infectious diseases at the Johns Hopkins University School of Medicine, told Healio.
“All of these conditions are often treatable,” Oluwaseun Falade-Nwulia said, “but care is fragmented, with patients having to go to different clinics to get diagnosed and get treatment.”
Falade-Nwulia and colleagues assessed data collected from participants enrolled in the CHAMPS study a randomized trial that compared usual care with peer support or cash incentives for increasing uptake in HCV treatment among people who use drugs. In the study, people with HIV and active HCV infection with no evidence of engagement in HCV care were enrolled between August 2015 and October 2016 and linked to HCV treatment, Falade-Nwulia and colleagues reported.
Among 144 people enrolled in the trial who used drugs, 110 began HCV treatment, including 100 who had data on self-reported drug use and urine toxicology at both enrollment and a 6-week visit.
According to the study, 48 of these participants reported using drugs within 30 days of enrollment, including opioids alone (33%), cocaine alone (40%) and a combination of opioids and cocaine (27%).
Additionally, 18 participants (18%) reported concurrent hazardous alcohol use and depression.
The researchers found that, at enrollment, participants with recent substance use were more likely to report depressive symptoms (70.8% vs 51.9%; P = .05) and hazardous alcohol use (35.4% vs 15.4%; P = .02) compared with those without recent use. Participants with recent substance use also showed a trend toward being more likely to have concurrent depressive symptoms and hazardous alcohol use (25% vs 11.5%; P = .08) compared with those without recent use, the said.
The study also demonstrated that during HCV treatment, most participants had ongoing active drug use (36%) or persistent drug use abstinence (46%). Among participants, 12% transitioned from active to inactive drug use, whereas 6% transitioned from inactive to active drug use. According to the study, 92% of participants who transitioned to inactive drug use reported abstinence from substance use at 12 weeks.
“The clinical take home is that HCV treatment is an opportunity to screen and link patients to treatment for substance abuse including alcohol use and mental health disorders,” Falade-Nwulia said. “This is important as it will improve patient overcomes overall, including reducing progression of liver disease from harmful levels of alcohol use, reducing HCV reinfection and improving substance use and mental health outcomes.”
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