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Chien CH, Chou TS, Chen LW, Lin CL, Chang JJ, Liu CJ, Chen SW, Hu CC, Chien RN. The Challenge of a Recall Program from a Community-Based Hepatitis C Screening Campaign: The Effectiveness in HCV Microelimination. Microorganisms 2024; 12:1402. [PMID: 39065170 PMCID: PMC11279112 DOI: 10.3390/microorganisms12071402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/03/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
The optimal strategy for the microelimination of HCV within community settings remains ambiguous. We evaluated the percentage of participants who achieved linkage to care (LTC) following the conclusion of a screening campaign and examined the diverse factors influencing LTC among these individuals. The effectiveness of recall intervention for the non-LTC population and its barriers were analyzed. We initiated an HCV patient recall program to identify HCV participants who might not be treated after the HCV screening campaign. The program staff recalled HCV participants who were lost to follow-up via telephone from March 2019 to June 2019. They were informed of HCV treatment's importance, efficacy, availability, and safety. Among 185 participants infected with HCV, 109 (58.9%) obtained LTC. Compared with those who had LTC, those without LTC were older, had lower education levels, were less aware of their HCV infection, less frequently lived in urban areas, and had less health insurance. At the end of the recall program, 125 (67.6%) persons had linkage to care. The proportion of LTC increased by 8.7%. In total, 119 persons had an HCV RNA test, and 82 (68.9%) had viremia. Of the 82 patients with viremia, 78 (95.1%) received antiviral therapy, and 76 (97.4%) achieved a sustained virological response. After a community screening campaign, 59% of participants with anti-HCV-positive tests had LTC. The recall program increased this by 9%. However, 32% of HCV participants still could not be linked to care. Outreach care for non-LTC patients is a method worth trying in order to achieve the microelimination of HCV in rural communities.
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Affiliation(s)
- Cheng-Hung Chien
- Liver Research Unit, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-H.C.); (T.-S.C.); (L.-W.C.); (C.-L.L.); (C.-C.H.)
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Tien-Shin Chou
- Liver Research Unit, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-H.C.); (T.-S.C.); (L.-W.C.); (C.-L.L.); (C.-C.H.)
- Division of Gastroenterology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (J.-J.C.); (C.-J.L.); (S.-W.C.)
| | - Li-Wei Chen
- Liver Research Unit, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-H.C.); (T.-S.C.); (L.-W.C.); (C.-L.L.); (C.-C.H.)
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Chih-Lang Lin
- Liver Research Unit, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-H.C.); (T.-S.C.); (L.-W.C.); (C.-L.L.); (C.-C.H.)
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Jia-Jang Chang
- Division of Gastroenterology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (J.-J.C.); (C.-J.L.); (S.-W.C.)
| | - Ching-Jung Liu
- Division of Gastroenterology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (J.-J.C.); (C.-J.L.); (S.-W.C.)
| | - Shuo-Wei Chen
- Division of Gastroenterology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (J.-J.C.); (C.-J.L.); (S.-W.C.)
| | - Ching-Chih Hu
- Liver Research Unit, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (C.-H.C.); (T.-S.C.); (L.-W.C.); (C.-L.L.); (C.-C.H.)
- Division of Gastroenterology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; (J.-J.C.); (C.-J.L.); (S.-W.C.)
| | - Rong-Nan Chien
- Liver Research Unit, Linkou Chang Gung Memorial Hospital and University College of Medicine, Taoyuan 333, Taiwan
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Shimu SJ, Patil SM, Dadzie E, Tesfaye T, Alag P, Więckiewicz G. Exploring Health Informatics in the Battle against Drug Addiction: Digital Solutions for the Rising Concern. J Pers Med 2024; 14:556. [PMID: 38929777 PMCID: PMC11204661 DOI: 10.3390/jpm14060556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/14/2024] [Accepted: 05/19/2024] [Indexed: 06/28/2024] Open
Abstract
Drug addiction is a rising concern globally that has deeply attracted the attention of the healthcare sector. The United States is not an exception, and the drug addiction crisis there is even more serious, with 10% of adults having faced substance use disorder, while around 75% of this number has been reported as not having received any treatment. Surprisingly, there are annually over 70,000 deaths reported as being due to drug overdose. Researchers are continually searching for solutions, as the current strategies have been ineffective. Health informatics platforms like electronic health records, telemedicine, and the clinical decision support system have great potential in tracking the healthcare data of patients on an individual basis and provide precise medical support in a private space. Such technologies have been found to be useful in identifying the risk factors of drug addiction among people and mitigating them. Moreover, the platforms can be used to check prescriptions of addictive drugs such as opioids and caution healthcare providers. Programs such as the Prescription Drug Monitoring Program (PDMP) and the Drug and Alcohol Services Information Systems (DASIS) are already in action in the US, but the situation demands more in-depth studies in order to mitigate substance use disorders. Artificial intelligence (AI), when combined with health informatics, can aid in the analysis of large amounts of patient data and aid in classifying nature of addiction to assist in the provision of personalized care.
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Affiliation(s)
- Shakila Jahan Shimu
- Department of Health Informatics, Harrisburg University of Science and Technology, Harrisburg, PA 17101, USA;
| | | | - Ebenezer Dadzie
- School of Clinical Medicine, Inner Mongolia University for the Nationalities, Tongliao 028000, China;
| | - Tadele Tesfaye
- CareHealth Medical Practice, Addis Ababa 9023, Ethiopia;
| | - Poorvanshi Alag
- Psychiatry Department, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA;
| | - Gniewko Więckiewicz
- Department of Psychiatry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
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Grebely J, Robaeys G, Bruggmann P, Aghemo A, Backmund M, Bruneau J, Byrne J, Dalgard O, Feld JJ, Hellard M, Hickman M, Kautz A, Litwin A, Lloyd AR, Mauss S, Prins M, Swan T, Schaefer M, Taylor LE, Dore GJ. Recommandations pour la prise en charge de l'infection par le virus de l'hépatite C chez les usagers de drogues par injection. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 111:101669. [PMID: 26847504 DOI: 10.1016/j.drugpo.2015.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
| | - Geert Robaeys
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Genk, Belgium; Department of Hepatology, UZ Leuven, Leuven, Belgium; Faculty of Medicine and Life Sciences, Limburg Clinical Research Program, Hasselt University, Hasselt, Belgium
| | | | - Alessio Aghemo
- A.M. Migliavacca Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Markus Backmund
- Ludwig-Maximilians-University, Munich, Germany; Praxiszentrum im Tal Munich, Munich, Germany
| | | | - Jude Byrne
- International Network of People who Use Drugs, Canberra, Australia
| | - Olav Dalgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
| | | | - Margaret Hellard
- Burnet Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Matthew Hickman
- School of Social & Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Achim Kautz
- European Liver Patients Association, Cologne, Germany
| | - Alain Litwin
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States
| | - Andrew R Lloyd
- Inflammation and Infection Research Centre, School of Medical Sciences, UNSW Australia, Sydney, Australia
| | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Düsseldorf, Germany
| | - Maria Prins
- Department of Research, Cluster Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands; Department of Internal Medicine, CINIMA, Academic Medical Centre, Amsterdam, The Netherlands
| | - Tracy Swan
- Treatment Action Group, New York, United States
| | - Martin Schaefer
- Department of Psychiatry, Psychotherapy and Addiction Medicine, Kliniken Essen-Mitte, Essen, Germany; Department of Psychiatry and Psychotherapy-CCM, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lynn E Taylor
- Department of Medicine, Brown University, Providence, RI, United States
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4
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Grebely J, Robaeys G, Bruggmann P, Aghemo A, Backmund M, Bruneau J, Byrne J, Dalgard O, Feld JJ, Hellard M, Hickman M, Kautz A, Litwin A, Lloyd AR, Mauss S, Prins M, Swan T, Schaefer M, Taylor LE, Dore GJ. Empfehlungen zur Hepatitis Versorgung bei Drogenkonsumierenden. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 111:101670. [PMID: 26749563 DOI: 10.1016/j.drugpo.2015.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | - Geert Robaeys
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Genk, Belgium; Department of Hepatology, UZ Leuven, Leuven, Belgium; Faculty of Medicine and Life Sciences, Limburg Clinical Research Program, Hasselt University, Hasselt, Belgium
| | | | - Alessio Aghemo
- A.M. Migliavacca Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Markus Backmund
- Ludwig-Maximilians-University, Munich, Germany; Praxiszentrum im Tal Munich, Munich, Germany
| | | | - Jude Byrne
- International Network of People who Use Drugs, Canberra, Australia
| | - Olav Dalgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
| | | | - Margaret Hellard
- Burnet Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Matthew Hickman
- School of Social & Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Achim Kautz
- European Liver Patients Association, Cologne, Germany
| | - Alain Litwin
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States
| | - Andrew R Lloyd
- Inflammation and Infection Research Centre, School of Medical Sciences, UNSW Australia, Sydney, Australia
| | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Düsseldorf, Germany
| | - Maria Prins
- Department of Research, Cluster Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands; Department of Internal Medicine, CINIMA, Academic Medical Centre, Amsterdam, The Netherlands
| | - Tracy Swan
- Treatment Action Group, New York, United States
| | - Martin Schaefer
- Department of Psychiatry, Psychotherapy and Addiction Medicine, Kliniken Essen-Mitte, Essen, Germany; Department of Psychiatry and Psychotherapy-CCM, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lynn E Taylor
- Department of Medicine, Brown University, Providence, RI, United States
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Supportive Interventions During Treatment of Chronic Hepatitis C: A Review of the Literature. Gastroenterol Nurs 2021; 43:E172-E183. [PMID: 33003028 DOI: 10.1097/sga.0000000000000488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
There are an estimated 3 million people living with chronic hepatitis C, yet many have limited access to healthcare and treatment due to a variety of behavioral/lifestyle determinants of health. The aim of this literature review was to examine care models and innovations for people successfully treated from 2011 to 2018. We searched PubMed, PsycINFO, and CINAHL to identify care models for people undergoing treatment of chronic hepatitis C. Ten articles met criteria for inclusion and included multiple types of care models, including nurse initiated (n = 2), telemedicine care (n = 3), group visit (n = 1), concurrent treatment (n = 1), community health center care (n = 1), and integrated care (n = 2). Eight of the studies focused on people with mental health challenges and/or substance use disorder. Sustained virological response was the primary outcome of all studies; adherence was a secondary outcome measured in 8 studies.This search occurred during a period where treatment moved from interferon-based therapy to all-oral direct-acting antiviral medications, representing a paradigm shift in treatment of chronic hepatitis C. As new treatments offer cure for up to 95% of patients, these studies provided strong evidence of benefit for innovative care models for patients with mental health and substance use disorder to complete treatment.
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Impact of Behavioral Health Consultation on Hepatitis C Treatment Outcomes at a Federally Qualified Health Center; Philadelphia, PA. J Prim Prev 2021; 42:203-215. [PMID: 33733379 DOI: 10.1007/s10935-021-00627-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2021] [Indexed: 10/21/2022]
Abstract
Hepatitis C virus (HCV) infection is a public health issue that claims the lives of 350,000 individuals globally every year. Primary care providers are increasingly prescribing HCV medications with more modern, simplified administrations. Individuals with HCV are disproportionately affected by behavioral health challenges and substance use disorders. Integrated behavioral health providers can work in concert with their patients' primary care teams to provide innovative treatment programs to help support the needs of HCV care. We used simple and multivariable logistic regression to determine the association between receipt of behavioral health consultation and two outcomes on the care continuum: insurance approval for treatment and initiated HCV treatment regimen. These models were fitted using theoretically hypothesized variables and multivariable regression models included age, sex, and race/ethnicity as potential confounders. From January 2015 to May 2017, 189 patients at health centers were referred for onsite HCV primary care treatment. Of these, 142 were approved for participation, and 132 started treatment. Simple regression revealed a significant association between behavioral health consultation and treatment approval; however, behavioral health consultation was non-significant in the multivariable model for treatment approval. For initiating HCV treatment, onsite behavioral health consultation was significantly associated in both the unadjusted and adjusted regression models. Integrating behavioral health services for patients seeking HCV treatment may improve movement across the care continuum, optimizing patient's HCV health outcomes. Behavioral health consultation in primary care settings should be studied further to improve HCV treatment outcomes for patients with behavioral health and substance use disorders.
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Fuchs M, Monto A, Bräu N, Charafeddine M, Schmidt W, Kozal M, Naggie S, Cheung R, Schnell G, Yu Y, Richards K, Mullally V, Cohen DE, Toro D. Ombitasvir/paritaprevir/ritonavir and dasabuvir±ribavirin for chronic HCV infection in US veterans with psychiatric disorders. J Med Virol 2020; 92:3459-3464. [PMID: 31829433 PMCID: PMC7687116 DOI: 10.1002/jmv.25655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 12/09/2019] [Indexed: 11/05/2022]
Abstract
Hepatitis C virus (HCV) infections are more common among US veterans receiving care through Veterans Affairs (VA) Medical Centers than among the general population. Historically, HCV therapies had lower efficacy rates in VA patients, possibly due to common comorbidities such as psychiatric disorders and substance abuse. The direct-acting antivirals ombitasvir/paritaprevir/ritonavir and dasabuvir (OBV/PTV/r+DSV)±ribavirin (RBV) are approved in the US for HCV genotype 1 (GT1)-infected adults with or without cirrhosis. This study prospectively evaluated the safety and efficacy of OBV/PTV/r+DSV±RBV in VA patients with HCV GT1 infection. TOPAZ-VA was a phase 3b, open-label trial. Adult US veterans with HCV GT1 infection, without cirrhosis or with compensated cirrhosis, were eligible for enrollment. Patients with GT1a infection received OBV/PTV/r +DSV+RBV for 12 weeks or 24 weeks (for those with cirrhosis); GT1b-infected patients without cirrhosis received OBV/PTV/r +DSV for 12 weeks; those with cirrhosis received OBV/PTV/r +DSV with RBV. The primary endpoint was sustained virologic response at posttreatment week 12 (SVR12); safety was also assessed. Ninety-nine patients were enrolled at 10 sites from May through November 2015. The majority were male (96%), white (60%), and with GT1a infection (68%); 49% reported ongoing psychiatric disorders. Overall, 94% (93/99) achieved SVR12; three patients had a virologic failure. The most common AEs were fatigue (28%), headache (20%), and nausea (15%); six patients discontinued treatment due to AEs. In US veterans with HCV GT1 infection, OBV/PTV/r +DSV±RBV yielded a 94% overall SVR12 rate and was well tolerated. The presence of psychiatric disorders and/or injection drug use did not impact efficacy.
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Affiliation(s)
- Michael Fuchs
- Hepatology Section, Hunter Holmes McGuire VA Medical CenterVirginia Commonwealth UniversityRichmondVirginia
| | - Alexander Monto
- Department of GastroenterologySan Francisco VA Medical CenterSan FranciscoCalifornia
| | - Norbert Bräu
- Viral Hepatitis ProgramJames J Peters VA Medical CenterNew York CityNew York
| | | | - Warren Schmidt
- Department of Internal MedicineIowa City VA Healthcare SystemIowa CityIowa
| | - Michael Kozal
- Department of Internal Medicine, VA Connecticut Healthcare System, Yale School of MedicineYale UniversityNew HavenConnecticut
| | - Susanna Naggie
- Department of MedicineDurham VA Medical CenterDurhamNorth Carolina
| | - Ramsey Cheung
- Department of Gastroenterology and HepatologyVA Palo Alto Healthcare SystemPalo AltoCalifornia
| | | | - Yao Yu
- AbbVie IncNorth ChicagoIllinois
| | | | | | | | - Doris Toro
- Gastroenterology SectionVA Caribbean Healthcare SystemSan JuanPuerto Rico
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Beyond clinical outcomes: the social and healthcare system implications of hepatitis C treatment. BMC Infect Dis 2020; 20:702. [PMID: 32972393 PMCID: PMC7517680 DOI: 10.1186/s12879-020-05426-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/16/2020] [Indexed: 12/19/2022] Open
Abstract
Background Hepatitis C virus (HCV) infections in people who inject drugs (PWID) can now be treated and cured. However, the impact that HCV treatment has on drug-user health, practices and wellbeing is not known. The aim of this research was to understand the non-clinical impact that HCV treatment has in PWID and their reasons for accessing and completing treatment. Methods Participants aged 25–67 years who had injected opioids or stimulants (currently or in the past) and had completed direct-acting antiviral treatment were recruited from seven European countries. Participants completed a 30-min online survey administered face-to-face between September 2018 and April 2019. The questionnaire responses were used to assess the mental and physical impact of having completed treatment. Results Of the 124 participants who completed the survey questionnaire, 75% were male, 69% were over 45 years old and 65% were using opioids and/or stimulants at the start of HCV treatment. Participants reported improvements in the following areas after completing HCV treatment: outlook for the future (79%); self-esteem (73%); ability to plan for the future (69%); belief in their abilities (68%); confidence (67%); empowerment (62%); energy levels (59%); and ability to look after themselves (58%). The most common reasons for starting HCV treatment were: becoming aware of treatments that were well tolerated (77%) and effective (75%); and understanding the potentially severe consequences of HCV (75%). Conclusions The benefits of HCV treatment go beyond clinical outcomes and are linked to improved drug-user health and wellbeing. Sharing information about well-tolerated and effective HCV treatments, and raising awareness about the potentially severe consequences of untreated HCV are likely to increase the number of PWID who are motivated to access and complete HCV treatment in future.
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Chiu WC, Lu ML, Chang CC. Mental Disorders and Interferon Nontreatment in Hepatitis C Virus Infection-a Population Based Cohort Study. Psychiatry Investig 2020; 17:268-274. [PMID: 32151125 PMCID: PMC7113179 DOI: 10.30773/pi.2019.0254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 01/08/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study investigates the association between mental disorders and interferon nontreatment in patients with chronic hepatitis C virus (HCV) infection in a large national sample. METHODS Using the National Health Insurance Research Database of Taiwan, we conducted a nationwide population-based study. Each case was matched to five controls by age, sex, urbanization, and income. Conditional logistic regression was used to assess odds of HCV nontreatment in different mental disorders. RESULTS From 1999 to 2013, we identified 92,970 subjects with HCV infection and 15,495 HCV cases (16.7%) had received IFN therapy. Other than chronic obstructive pulmonary disease, the medical diseases and mental disorders were significantly different between IFN and non-IFN treated HCV patients. After adjusting for medical diseases, depressive disorder and anxiety disorder was positively associated with receiving IFN therapy. Patients with schizophrenia, bipolar disorders and alcohol use disorders were significantly less likely to receive interferon. Antidepressant exposure (cumulative daily exposure or cumulative daily dose) was associated with lower odds of IFN treatment. CONCLUSION Our nationwide cohort study demonstrated that INF nontreatment rate was lower in certain mental disorders. Antidepressant exposure might lower the chance of receiving IFN treatment. Our results may help to identify and to overcome the obstacles for HCV treatment and further apply to DAAs regimen.
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Affiliation(s)
- Wei-Che Chiu
- Department of Psychiatry, Cathay General Hospital, Taipei, Taiwan.,School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
| | - Mong-Liang Lu
- Department of Psychiatry, Wan-Fang Hospital, Taipei, Taiwan.,School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Cheng-Chen Chang
- Department of Psychiatry, Changhua Christian Hospital, Changhua, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Center of General Education, Tunghai University, Taichung, Taiwan
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Barré T, Marcellin F, Di Beo V, Delorme J, Rojas Rojas T, Mathurin P, Protopopescu C, Bailly F, Coste M, Authier N, Carrieri MP, Rolland B. Untreated alcohol use disorder in people who inject drugs (PWID) in France: a major barrier to HCV treatment uptake (the ANRS-FANTASIO study). Addiction 2020; 115:573-582. [PMID: 31595554 PMCID: PMC7027887 DOI: 10.1111/add.14820] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/11/2019] [Accepted: 09/06/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Although people who inject drugs (PWID) are the core at-risk population in the hepatitis C virus (HCV) epidemic in industrialized countries, few initiate treatment. Alcohol use disorder (AUD), common within this population, has been identified as a barrier to HCV treatment uptake in the general population. We investigated whether the arrival of new and well-tolerated HCV treatments (direct-acting antivirals: DAA) has improved HCV treatment uptake in French PWID compared with former treatments (pegylated interferon-based treatments: Peg-IFN). DESIGN Using discrete-time Cox proportional hazards models based on exhaustive care delivery data, we tested for associations between AUD (defined by AUD-related long-term illness status, diagnosis coding during hospitalization and/or AUD pharmacological treatment) and first HCV treatment delivery, after adjusting for gender, age, complementary universal health cover, liver disease severity and type of opioid agonist therapy (OAT) received. Separate analyses were performed for 2012-13 (Peg-IFN era) and 2014-16 (DAA era). SETTING France. PARTICIPANTS All French people chronically HCV-infected who received OAT at least once during 2012-16 and were covered by the national health insurance (n = 24 831). MEASUREMENTS Incidence rate of HCV treatment uptake, hazard ratios associated with AUD and other covariates. FINDINGS Incidence rate (IR) of HCV treatment uptake per 100 person-years was 6.56, confidence interval (CI) = 6.30-6.84; and IR = 5.70, 95% CI = 5.51-5.89 for Peg-IFN-based treatment (2012-13) and DAA (2014-16), respectively. After multiple adjustment, people with AUD not receiving related medication had 30 and 14% lower Peg-IFN-based treatment and DAA uptake, respectively, than those without AUD [hazard ratio (HR) = 0.70, 95% CI = 0.62-0.80 and HR = 0.86, 95% CI = 0.78-0.94]. No difference was observed between those treated for AUD and those without AUD. CONCLUSIONS Despite the benefits of direct-acting antiviral treatment, untreated alcohol use disorder appears to remain a major barrier to hepatitis C virus treatment access for people who inject drugs in France.
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Affiliation(s)
- Tangui Barré
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information MédicaleMarseilleFrance,ORS PACA, Observatoire Régional de la Santé Provence‐Alpes‐Côte d'AzurMarseilleFrance
| | - Fabienne Marcellin
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information MédicaleMarseilleFrance,ORS PACA, Observatoire Régional de la Santé Provence‐Alpes‐Côte d'AzurMarseilleFrance
| | - Vincent Di Beo
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information MédicaleMarseilleFrance,ORS PACA, Observatoire Régional de la Santé Provence‐Alpes‐Côte d'AzurMarseilleFrance
| | - Jessica Delorme
- CHU Clermont‐Ferrand, Neuro‐Dol, Service de pharmacologie médicale, Centres addictovigilance et pharmacovigilanceUniversité Clermont AuvergneClermont‐FerrandFrance
| | - Teresa Rojas Rojas
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information MédicaleMarseilleFrance,ORS PACA, Observatoire Régional de la Santé Provence‐Alpes‐Côte d'AzurMarseilleFrance
| | - Philippe Mathurin
- Service des maladies de l'appareil digestif, CHU LilleUniversité de LilleLilleFrance
| | - Camelia Protopopescu
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information MédicaleMarseilleFrance,ORS PACA, Observatoire Régional de la Santé Provence‐Alpes‐Côte d'AzurMarseilleFrance
| | - François Bailly
- Service d'hépatologie et d'addictologie, Groupe hospitalier Nord, Hôpital de la Croix‐RousseLyonFrance
| | - Marion Coste
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information MédicaleMarseilleFrance,ORS PACA, Observatoire Régional de la Santé Provence‐Alpes‐Côte d'AzurMarseilleFrance
| | - Nicolas Authier
- CHU Clermont‐Ferrand, Neuro‐Dol, Service de pharmacologie médicale, Centres addictovigilance et pharmacovigilanceUniversité Clermont AuvergneClermont‐FerrandFrance
| | - Maria Patrizia Carrieri
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information MédicaleMarseilleFrance,ORS PACA, Observatoire Régional de la Santé Provence‐Alpes‐Côte d'AzurMarseilleFrance
| | - Benjamin Rolland
- Service Universitaire d'Addictologie de Lyon (SUAL), CH Le VinatierUniversité de LyonBronFrance
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Lier AJ, Smith K, Odekon K, Bronson S, Taub E, Tharakan M, Kelly GJ, Patel P, Marcos LA. Risk Factors Associated with Linkage to Care among Suburban Hepatitis C-Positive Baby Boomers and Injection Drug Users. Infect Dis Ther 2019; 8:417-428. [PMID: 31129777 PMCID: PMC6702540 DOI: 10.1007/s40121-019-0249-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Suffolk County, located in Eastern Long Island, has been an epicenter for the opioid epidemic in New York State, yet no studies have examined hepatitis C virus (HCV) prevalence in this population. Additionally, few studies have assessed barriers for linkage to care (LTC) to HCV treatment in people who inject drugs (PWID), a high-risk HCV cohort. We aimed to determine prevalence of HCV infection in a suburban medical center and to assess risk factors associated with LTC in HCV-positive baby boomers and young PWID. METHODS A retrospective chart review was carried out on adult patients with ICD-9/10 diagnostic codes for HCV from January 2016 to December 2018 at Stony Brook Medicine. Data collected included sociodemographics, RNA serostatus, LTC, health insurance, employment, past medical or psychiatric history, and substance or injection drug use. RESULTS Overall, 27,049 individuals were screened for HCV and 1017 were HCV seropositive (3.8%), 437 (42.9%) were HCV RNA-positive and 153 (40.6%) achieved LTC. In multivariate analysis, living with cirrhosis was associated with a positive LTC. Medicaid or Medicare insurance was associated with a negative LTC. Intravenous drug users were more likely to be young and have concomitant polysubstance use and psychiatric disease. A bimodal distribution of HCV-positives is present in our population. CONCLUSION Those with liver cirrhosis are more likely to achieve LTC, as are those with private insurance. Public health efforts to promote awareness of HCV and to facilitate access to treatment among PWID are needed.
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Affiliation(s)
- Audun J Lier
- Department of Internal Medicine, Stony Brook University Hospital, New York, USA.
| | - Kalie Smith
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University Hospital, New York, USA
| | - Kerim Odekon
- Department of Internal Medicine, Stony Brook University Hospital, New York, USA
| | - Silvia Bronson
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University Hospital, New York, USA
| | - Erin Taub
- Department of Internal Medicine, Stony Brook University Hospital, New York, USA
| | - Mathew Tharakan
- Department of Internal Medicine, Stony Brook University Hospital, New York, USA
| | - Gerald J Kelly
- Division of Family and Community Medicine, Department of Family, Population and Preventive Medicine, Stony Brook University Hospital, New York, USA
| | - Pruthvi Patel
- Division of Gastroenterology, Department of Internal Medicine, Stony Brook University Hospital, New York, USA
| | - Luis A Marcos
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University Hospital, New York, USA
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12
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Carrillo de Albornoz Calahorro CM, Navarrete Paez MI, Guerrero Jimenez M, Gutierrez Rojas L. Successful treatment of psychosis induced by interferon alpha and ribavirin with paliperidone: first case reported. Gen Psychiatr 2019; 32:e100075. [PMID: 31552385 PMCID: PMC6738683 DOI: 10.1136/gpsych-2019-100075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/10/2019] [Accepted: 05/27/2019] [Indexed: 12/11/2022] Open
Abstract
Several clinical studies have shown a large number of mental symptoms by immunomodulatory treatment with interferon (IFN). The most frequently described symptoms are depression, suicidal behaviour, manic symptoms, anxiety, psychosis and delirium, associated with other non-specific symptoms such as fatigue, irritability, psychomotor retardation, decreased libido, insomnia, difficulty in concentration and attention. Having a history of mental disorder contraindicates the use of IFN-alpha. These adverse effects that affect the mental state appear usually at the beginning of the treatment (most after 3 weeks of treatment). The incidence of psychotic episodes is low and the episodes usually remit when treatment is interrupted; only some cases require antipsychotic treatment. We present the case of a patient affected with hepatitis C who began to present self-referential delirious symptoms after receiving the treatment with IFN and who was successfully treated with paliperidone. This patient could be classified within the group of high-risk psychiatric patients given the family history of schizophrenia and his personal history of illegal drug consumption. The pharmacological actions of paliperidone are similar to other high potency atypical antipsychotics. The receptor-binding profile of paliperidone most closely resembles that of risperidone and ziprasidone. Paliperidone differs from risperidone and most other antipsychotics by its relatively low extent of enzymatic hepatic metabolism. To the best of our knowledge, this is the first case described that was successfully treated with paliperidone.
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13
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Salvetat N, Van der Laan S, Vire B, Chimienti F, Cleophax S, Bronowicki JP, Doffoel M, Bourlière M, Schwan R, Lang JP, Pujol JF, Weissmann D. RNA editing blood biomarkers for predicting mood alterations in HCV patients. J Neurovirol 2019; 25:825-836. [PMID: 31332697 PMCID: PMC6920238 DOI: 10.1007/s13365-019-00772-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 03/13/2019] [Accepted: 06/03/2019] [Indexed: 12/19/2022]
Abstract
Treatment-emergent depression is a common complication in patients with chronic hepatitis C virus (HCV) infection undergoing antiviral combination therapy with IFN-α and ribavirin. It has recently been shown that changes in A-to-I RNA editing rates are associated with various pathologies such as inflammatory disorders, depression and suicide. Interestingly, IFN-α induces gene expression of the RNA editing enzyme ADAR1-1 (ADAR1a-p150) and alters overall RNA editing activity. In this study, we took advantage of the high prevalence of pharmacologically induced depression in patients treated with IFN-α and ribavirin to test the interest of RNA editing–related biomarkers in white blood cells of patients. In this 16-week longitudinal study, a small cohort of patients was clinically evaluated using standard assessment methods prior to and during antiviral therapy and blood samples were collected to analyse RNA editing modifications. A-I RNA editing activity on the phosphodiesterase 8A (PDE8A) gene, a previously identified RNA editing hotspot in the context of lupus erythematosus, was quantified by using an ultra-deep next-generation sequencing approach. We also monitored gene expression levels of the ADAR enzymes and the PDE8A gene during treatment by qPCR. As expected, psychiatric evaluation could track treatment-emergent depression, which occurred in 30% of HCV patients. We show that PDE8A RNA editing is increased in all patients following interferon treatment, but differently in 30% of patients. This effect was mimicked in a cellular model using SHSY-5Y neuroblastoma cells. By combining the data of A-I RNA editing and gene expression, we generated an algorithm that allowed discrimination between the group of patients who developed a treatment-emergent depression and those who did not. The current model of drug-induced depression identified A-I RNA editing biomarkers as useful tools for the identification of individuals at risk of developing depression in an objective, quantifiable biological blood test.
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Affiliation(s)
- N Salvetat
- ALCEDIAG, Sys2Diag / CNRS UMR9005, Parc Euromédecine Cap Delta, 1682 Rue de la Valsière, 34184, Montpellier Cedex 4, France.
| | - S Van der Laan
- ALCEDIAG, Sys2Diag / CNRS UMR9005, Parc Euromédecine Cap Delta, 1682 Rue de la Valsière, 34184, Montpellier Cedex 4, France
| | - B Vire
- ALCEDIAG, Sys2Diag / CNRS UMR9005, Parc Euromédecine Cap Delta, 1682 Rue de la Valsière, 34184, Montpellier Cedex 4, France
| | - F Chimienti
- ALCEDIAG, Sys2Diag / CNRS UMR9005, Parc Euromédecine Cap Delta, 1682 Rue de la Valsière, 34184, Montpellier Cedex 4, France
| | - S Cleophax
- Biocortech, rue de la Croix Jarry, 75013, Paris, France.,Etablissement Français du Sang, 2 avenue Ile de France, 95300, Pontoise, France
| | - J P Bronowicki
- Hepato-Gastroenterology, Hopital Brabois- CHU Nancy, 54511, Vandoeuvre-les-Nancy, France
| | - M Doffoel
- Université de Strasbourg, Hopital Universitaire de Strasbourg, 67000, Strasbourg, France
| | - M Bourlière
- Hepato-Gastroenterology, Hopital Saint Joseph, 13285, Marseille, France
| | - R Schwan
- Hepato-Gastroenterology, Hopital Brabois- CHU Nancy, 54511, Vandoeuvre-les-Nancy, France
| | - J P Lang
- Université de Strasbourg, Hopital Universitaire de Strasbourg, 67000, Strasbourg, France.,Les Toises, Centre de psychiatrie et psychothérapie, Lausanne, Switzerland
| | - J F Pujol
- ALCEDIAG, Sys2Diag / CNRS UMR9005, Parc Euromédecine Cap Delta, 1682 Rue de la Valsière, 34184, Montpellier Cedex 4, France.,Biocortech, rue de la Croix Jarry, 75013, Paris, France
| | - D Weissmann
- ALCEDIAG, Sys2Diag / CNRS UMR9005, Parc Euromédecine Cap Delta, 1682 Rue de la Valsière, 34184, Montpellier Cedex 4, France.,Biocortech, rue de la Croix Jarry, 75013, Paris, France
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14
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Caven M, Malaguti A, Robinson E, Fletcher E, Dillon JF. Impact of Hepatitis C treatment on behavioural change in relation to drug use in people who inject drugs: A systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:169-176. [PMID: 31109776 DOI: 10.1016/j.drugpo.2019.05.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 05/08/2019] [Accepted: 05/10/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND A systematic review was conducted to determine the impact of Hepatitis C (HCV) treatment on substance use behaviour in people who inject drugs (PWID). METHODS A search for peer reviewed journal articles from 1991 to present day was conducted using the following databases: PubMed, EMBASE, CINAHL and PsycINFO. Studies were appraised against the following inclusion criteria: recruitment of PWID for HCV treatment (either interferon alpha or direct acting antivirals based); measurement of behavioural change in relation to drug use; studies published in English. RESULTS Five studies investigating the impact of HCV treatment on behavioural change in relation to drug use amongst PWID were identified. Studies investigated the impact of HCV treatment on past month injecting drug use (four studies), injecting frequency (two studies), needle and syringe borrowing (two studies) and injecting equipment sharing (three studies). Three of the four studies assessing impact of treatment on past month injecting frequency found treatment significantly reduced the odds of participants reporting past month injecting at follow up. One study found that there was significant reduction in weekly injecting frequency between enrolment, treatment and follow up. No association was found between treatment engagement and needle and syringe borrowing. Two out of three studies reported a significant decrease in injecting equipment sharing between enrolment, treatment and follow up. CONCLUSIONS Comparison and synthesis of results was challenging due to heterogeneity between studies. Moreover, four out of the five selected studies were conducted during the interferon era of treatment, possibly limiting the generalisability of the current review's results to the new DAA treatment era. However, it is likely that engaging in treatment has a positive impact upon patients' injecting drug use and injection equipment sharing behaviour. This raises the possibility that this may be an opportune time for further harm reduction measures.
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Affiliation(s)
- Madeleine Caven
- School of Medicine, University of Dundee, Dundee, Scotland, United Kingdom.
| | - Amy Malaguti
- School of Medicine, University of Dundee, Dundee, Scotland, United Kingdom; Public Health Directorate, NHS Tayside, Kings Cross Hospital, Dundee, Scotland, United Kingdom; School of Social Sciences (Psychology), University of Dundee, Dundee, Scotland, United Kingdom; Adult Psychological Therapies Service, NHS Tayside, 15 Dudhope Terrace, Dundee, Scotland, United Kingdom
| | - Emma Robinson
- School of Medicine, University of Dundee, Dundee, Scotland, United Kingdom; Department of Gastroenterology, NHS Tayside, Ninewells Hospital, Dundee, Scotland, United Kingdom
| | - Emma Fletcher
- School of Medicine, University of Dundee, Dundee, Scotland, United Kingdom; Public Health Directorate, NHS Tayside, Kings Cross Hospital, Dundee, Scotland, United Kingdom
| | - John F Dillon
- School of Medicine, University of Dundee, Dundee, Scotland, United Kingdom; Department of Gastroenterology, NHS Tayside, Ninewells Hospital, Dundee, Scotland, United Kingdom
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15
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Delile JM, de Ledinghen V, Jauffret-Roustide M, Roux P, Reiller B, Foucher J, Dhumeaux D. Hepatitis C virus prevention and care for drug injectors: the French approach. HEPATOLOGY, MEDICINE AND POLICY 2018; 3:7. [PMID: 30288330 PMCID: PMC5987624 DOI: 10.1186/s41124-018-0033-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 05/29/2018] [Indexed: 12/14/2022]
Abstract
After France removed hepatitis C treatment reimbursement restrictions on 25 May 2016, an expert report presented recommendations, which focused on vulnerable groups including people who inject drugs (PWID). This commentary presents the key points of the chapter with a particular focus on policy. Thanks to the official lifting of restrictions based on disease stage and to the excellent efficacy and tolerance of the new DAA (Direct-Acting Antivirals) among PWID, the main issue is to improve the HCV care cascade. In France, many HCV-infected PWID, especially active/current PWID, remain undiagnosed and unlinked to care. Our challenge is to improve HCV screening by point of care testing (POCT), outreach methods with mobile teams, rapid tests, FibroScan, etc. and to provide PWID with appropriate services in all the settings they attend, such as drug treatment or harm reduction services, social services, prisons, etc. Another important issue is the prevention of reinfection through comprehensive and long-term follow-up. The report recommends a new national policy: testing and treating PWID as a priority, since this is the best way to eliminate HCV infection. It requires a global strategy consisting of combined and long-term interventions: prevention, outreach, screening, DAA, drug treatment programs including opiate substitution treatment (OST) and various harm reduction programs, including needle exchange programs (NEP). Ideally, these services should be delivered in the same place with an integrated approach. This should lead to meeting the national objective set by the government of eliminating hepatitis C by 2025.
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Affiliation(s)
- Jean-Michel Delile
- Comité d’étude et d’information sur la drogue et les addictions (CEID), 20, place Pey-Berland, 33000 Bordeaux, France
| | | | - Marie Jauffret-Roustide
- Cermes 3 (Inserm U988/CNRS UMR 8211/EHESS/Paris Descartes University) and French National Public Health Agency, Paris, France
| | - Perrine Roux
- Inserm UMR1252/IRD/SESSTIM/Aix-Marseille University/ORS PACA, Marseille, France
| | - Brigitte Reiller
- Comité d’étude et d’information sur la drogue et les addictions (CEID), 20, place Pey-Berland, 33000 Bordeaux, France
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16
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Miarons M, Sánchez-Ulayar A, Sempere G, Marín S, Castellví JM. New direct-acting antivirals for hepatitis C treatment and neuropsychiatric symptoms in psychiatric risk groups. Eur J Hosp Pharm 2018; 26:135-139. [PMID: 31428320 DOI: 10.1136/ejhpharm-2017-001352] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 01/08/2018] [Accepted: 01/09/2018] [Indexed: 12/26/2022] Open
Abstract
Objectives The new direct-acting antivirals (DAAs) have changed chronic hepatitis C virus (HCV) treatment perspectives by achieving success rates in all genotypes and by reducing the associated adverse effects in comparison to pegylated interferon α regimens. These adverse effects include depression, insomnia and suicidal intention, which make it difficult to treat psychiatric risk groups. The objectives of this study were to evaluate the neuropsychiatric symptoms during HCV treatment with DAAs in standard multidisciplinary clinical practice in psychiatric risk groups and to assess the risk factors associated with neuropsychiatric symptoms in this study population. Methods A prospective cross-sectional study was performed of all consecutive patients with psychiatric risk and HCV infection who completed treatment with the new DAAs at the ambulatory care pharmacy. We recorded demographic and clinical data, neuropsychiatric symptoms, emergency consultations, admissions to the psychiatric unit and interventions to manage neuropsychiatric symptoms. Statistical analysis was used to assess the association between neuropsychiatric symptoms and clinical data. Results We included 48 patients with psychiatric risk and detected 36 neuropsychiatric symptoms in 17 (35.4%) patients, with a mean of 0.75 neuropsychiatric symptoms per patient. However, no studied risk factors for developing neuropsychiatric symptoms were found in this population. Conclusions We found a moderate prevalence of neuropsychiatric symptoms in the psychiatric risk group. The neuropsychiatric symptoms more frequently reported were insomnia (17%), irritability (15%) and depression (13%). Neuropsychiatric symptoms in patients with psychiatric risk can occur during treatment with DAAs but less frequently than with pegylated interferon α regimens, and so is a safe treatment for these patients.
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Affiliation(s)
- Marta Miarons
- Department of Pharmacy, Mataró Hospital, Mataró, Spain
| | | | - Glòria Sempere
- Nursing Infectious Diseases Unit, Mataró Hospital, Mataró, Spain
| | - Sergio Marín
- Department of Pharmacy, Mataró Hospital, Mataró, Spain
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17
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Michel L, Lions C, Winnock M, Lang JP, Loko MA, Rosenthal E, Marchou B, Valantin MA, Morlat P, Roux P, Sogni P, Spire B, Poizot-Martin I, Lacombe K, Lascoux-Combe C, Duvivier C, Neau D, Dabis F, Salmon-Ceron D, Carrieri MP. Psychiatric and substance use disorders in HIV/hepatitis C virus (HCV)-coinfected patients: does HCV clearance matter? [Agence Nationale de Recherche sur le SIDA et les Hépatites Virales (ANRS) HEPAVIH CO13 cohort]. HIV Med 2017; 17:758-765. [PMID: 27187027 DOI: 10.1111/hiv.12382] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objective of this nested study was to assess the prevalence of psychiatric disorders in a sample of HIV/hepatitis C virus (HCV)-coinfected patients according to their HCV status. METHODS The nested cross-sectional study, untitled HEPAVIH-Psy survey, was performed in a subset of HIV/HCV-coinfected patients enrolled in the French Agence Nationale de Recherche sur le SIDA et les Hépatites Virales (ANRS) CO13 HEPAVIH cohort. Psychiatric disorders were screened for using the Mini International Neuropsychiatric Interview (MINI 5.0.0). RESULTS Among the 286 patients enrolled in the study, 68 (24%) had never received HCV treatment, 87 (30%) were treatment nonresponders, 44 (15%) were currently being treated and 87 (30%) had a sustained virological response (SVR). Of the 286 patients enrolled, 121 patients (42%) screened positive for a psychiatric disorder other than suicidality and alcohol/drug abuse/dependence, 40 (14%) screened positive for alcohol abuse/dependence, 50 (18%) screened positive for drug abuse/dependence, 50 (17.5%) were receiving an antidepressant treatment and 69 (24%) were receiving an anxiolytic. Patients with an SVR did not significantly differ from the other groups in terms of psychiatric disorders. Patients receiving HCV treatment screened positive less often for an anxiety disorder. The highest rate of drug dependence/abuse was among HCV treatment-naïve patients. CONCLUSIONS Psychiatric disorders were frequent in HIV/HCV-coinfected patients and their rates were comparable between groups, even for patients achieving an SVR. Our results emphasize the need for continuous assessment and care of coinfected patients, even after HCV clearance. Drug addiction remains an obstacle to access to HCV treatment. Despite the recent advent and continued development of directly acting antiviral agents (DAAs), it is still crucial to offer screening and comprehensive care for psychiatric and addictive disorders.
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Affiliation(s)
- L Michel
- Inserm U1178, Paris, France. .,UMRS1178, Paris-Sud University and Paris Descartes University, Paris, France. .,Centre Pierre Nicole, French Red Cross, Paris, France.
| | - C Lions
- Inserm U912 (SESSTIM), Marseille, France.,IRD, UMR-S912, Aix Marseille University, Marseille, France.,Regional Center for Disease Control Provence Alpes Côte d'Azur, Marseille, France
| | | | - J-P Lang
- CHRU Strasbourg, Strasbourg, France
| | | | | | | | - M-A Valantin
- Groupe Hospitalier La Pitié Salpêtrière, Paris, France
| | - P Morlat
- Hôpital Saint-André, Bordeaux, France
| | - P Roux
- Inserm U912 (SESSTIM), Marseille, France.,IRD, UMR-S912, Aix Marseille University, Marseille, France.,Regional Center for Disease Control Provence Alpes Côte d'Azur, Marseille, France
| | - P Sogni
- Hôpital Cochin, Paris, France
| | - B Spire
- Inserm U912 (SESSTIM), Marseille, France.,IRD, UMR-S912, Aix Marseille University, Marseille, France.,Regional Center for Disease Control Provence Alpes Côte d'Azur, Marseille, France
| | | | - K Lacombe
- Hôpital Saint-Antoine, Paris, France
| | | | | | - D Neau
- Hôpital Pellegrin, Bordeaux, France
| | - F Dabis
- Inserm U897, Bordeaux, France
| | | | - M P Carrieri
- Inserm U912 (SESSTIM), Marseille, France.,IRD, UMR-S912, Aix Marseille University, Marseille, France.,Regional Center for Disease Control Provence Alpes Côte d'Azur, Marseille, France
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18
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Midgard H, Hajarizadeh B, Cunningham EB, Conway B, Backmund M, Bruggmann P, Bruneau J, Bourgeois S, Dunlop A, Foster GR, Hellard M, Robaeys G, Thurnheer MC, Weltman M, Amin J, Marks PS, Quiene S, Dore GJ, Dalgard O, Grebely J. Changes in risk behaviours during and following treatment for hepatitis C virus infection among people who inject drugs: The ACTIVATE study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017. [PMID: 28633998 DOI: 10.1016/j.drugpo.2017.05.040] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The risk of hepatitis C virus (HCV) reinfection due to continued injecting risk behaviours might remain a barrier to HCV treatment among people who inject drugs. We aimed to evaluate changes in risk behaviours during and following HCV treatment among people with ongoing injecting drug use or receiving opioid substitution treatment (OST). METHODS ACTIVATE was an international multicentre clinical trial conducted between 2012 and 2014. Participants with HCV genotypes 2/3 infection were treated with peg-interferon/ribavirin for 12 or 24 weeks and completed a self-administered behavioural questionnaire at each study visit. The impact of time in treatment and follow-up on longitudinally measured recent (past month) behavioural outcomes was evaluated using generalized estimating equations. RESULTS Among 93 enrolled participants (83% male, median age 41 years), 55 (59%) had injected in the past month. Any injecting drug use decreased during HCV treatment and follow-up (OR 0.89 per incremental study visit; 95% CI 0.83-0.95). No significant changes were found in ≥daily injecting (OR 0.98; 95% CI 0.89-1.07), use of non-sterile needles (OR 0.94; 95% CI 0.79-1.12), sharing of injecting paraphernalia (OR 0.87; 95% CI 0.70-1.07) or non-injecting drug use (OR 1.01; 95% CI 0.92-1.10). Hazardous alcohol use decreased throughout (OR 0.56; 95% CI 0.40-0.77) and OST increased between enrolment and end of treatment (OR 1.48; 95% CI 1.07-2.04). CONCLUSIONS Recent injecting drug use and hazardous alcohol use decreased, while OST increased during and following HCV treatment among participants with ongoing injecting drug use. These findings support further expansion of HCV care among PWID.
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Affiliation(s)
- Håvard Midgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Norway; The Kirby Institute, UNSW Sydney, Australia; Department of Gastroenterology, Oslo University Hospital, Oslo, Norway.
| | | | | | - Brian Conway
- Vancouver Infectious Diseases Center, Vancouver, Canada
| | | | | | - Julie Bruneau
- CHUM Research Center, Université de Montréal, Montreal, Canada
| | | | - Adrian Dunlop
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Graham R Foster
- The Liver Unit, Queen Mary University of London, London, United Kingdom
| | | | - Geert Robaeys
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Genk, Belgium; Department of Hepatology, UZ Leuven, Leuven, Belgium; Faculty of Medicine and Life Sciences, Limburg Clinical Research Program, Hasselt University, Hasselt, Belgium
| | - Maria C Thurnheer
- Division of Infectious Diseases, University Hospital and University of Bern, Bern, Switzerland
| | | | - Janaki Amin
- The Kirby Institute, UNSW Sydney, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | | | | | | | - Olav Dalgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Norway
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19
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Gonzalez SA, Fierer DS, Talal AH. Medical and Behavioral Approaches to Engage People Who Inject Drugs Into Care for Hepatitis C Virus Infection. ADDICTIVE DISORDERS & THEIR TREATMENT 2017; 16:S1-S23. [PMID: 28701904 PMCID: PMC5491232 DOI: 10.1097/adt.0000000000000104] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Direct-acting antivirals for hepatitis C virus infection may revolutionize treatment among persons with substance use disorders. Despite persons with substance use disorders having the highest hepatitis C virus prevalence and incidence, the vast majority have not engaged into care for the infection. Previously, interferon-based treatments, with substantial side effects and the propensity to exacerbate mental health conditions, were major disincentives to pursuit of care for the infection. Direct-acting antivirals with viral eradication rates of >90%, significantly improved side effect profiles, and shorter treatment duration are dramatic improvements over prior treatment regimens that should promote widespread hepatitis C virus care among persons with substance use disorders. The major unmet need is strategies to promote persons with substance use disorders engagement into care for hepatitis C virus. Although physical integration of treatment for substance use and co-occurring conditions has been widely advocated, it has been difficult to achieve. Telemedicine offers an opportunity for virtual integration of behavioral and medical treatments that could be supplemented by conventional interventions such as hepatitis C virus education, case management, and peer navigation. Furthermore, harm reduction and strategies to reduce viral transmission are important to cease reinfection among persons with substance use disorders. Widespread prescription of therapy for hepatitis C virus infection to substance users will be required to achieve the ultimate goal of global virus elimination. Combinations of medical and behavioral interventions should be used to promote persons with substance use disorders engagement into and adherence with direct-acting antiviral-based treatment approaches. Ultimately, either physical or virtual colocation of hepatitis C virus and substance use treatment has the potential to improve adherence and consequently treatment efficacy.
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Affiliation(s)
- Stevan A. Gonzalez
- Division of Hepatology, Baylor Simmons Transplant Institute, Fort Worth, TX
| | | | - Andrew H. Talal
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine, State University of New York at Buffalo, Buffalo, NY
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20
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Islam N, Krajden M, Shoveller J, Gustafson P, Gilbert M, Buxton JA, Wong J, Tyndall MW, Janjua NZ. Incidence, risk factors, and prevention of hepatitis C reinfection: a population-based cohort study. Lancet Gastroenterol Hepatol 2017; 2:200-210. [DOI: 10.1016/s2468-1253(16)30182-0] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 11/17/2016] [Accepted: 11/17/2016] [Indexed: 02/06/2023]
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21
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Depression, Anxiety, and Stress Among People With Chronic Hepatitis C Virus Infection and a History of Injecting Drug Use in New South Wales, Australia. J Addict Med 2017; 11:10-18. [DOI: 10.1097/adm.0000000000000261] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Martin-Subero M, Diez-Quevedo C. Mental disorders in HIV/HCV coinfected patients under antiviral treatment for hepatitis C. Psychiatry Res 2016; 246:173-181. [PMID: 27718466 DOI: 10.1016/j.psychres.2016.09.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 07/27/2016] [Accepted: 09/24/2016] [Indexed: 12/14/2022]
Abstract
This paper aims to review the epidemiology and management of mental disorders in human immunodeficiency virus (HIV)/hepatitis C virus (HCV) coinfected patients, the need for antiviral therapy in this specific population, and current treatment strategies for HIV/HCV patients with psychiatric and/or substance use disorders. This is a narrative review. Data was sourced from electronic databases and was not limited by language or date of publication. HIV infection has become a survivable chronic illness. Prevalence of HCV infection among HIV-infected patients is high ranging from 50% to 90%. Patients with psychiatric diseases have also an increased risk for HIV/HCV coinfection. The most effective strategy to decrease HCV-related morbidity and mortality in coinfection is to achieve viral eradication. Although psychiatric symptoms often appear during antiviral treatment and may be associated with the use of interferon-alpha (IFN-α), recent evidence suggests that many patients with comorbid mental and substance use disorders can be treated safely. Recent data indicate that IFNα-induced psychiatric side effects have a similar prevalence in HIV/HCV coinfected patients than in monoinfected patients and they can be managed and even prevented successfully with psychopharmacological strategies in the frame of a multidisciplinary team. New antivirals offer INF-free therapies for this specific population.
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Affiliation(s)
- Marta Martin-Subero
- FIDMAG Research Foundation, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Badalona, Spain.
| | - Crisanto Diez-Quevedo
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Badalona, Spain; Department of Psychiatry, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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Grebely J, Robaeys G, Bruggmann P, Aghemo A, Backmund M, Bruneau J, Byrne J, Dalgard O, Feld JJ, Hellard M, Hickman M, Kautz A, Litwin A, Lloyd AR, Mauss S, Prins M, Swan T, Schaefer M, Taylor LE, Dore GJ. Recomendaciones para el manejo de la infección por el virus de la hepatitis C entre usuarios de drogas por vía parenteral. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015. [DOI: 10.1016/j.drugpo.2015.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Michel L, Lions C, Maradan G, Mora M, Marcellin F, Morel A, Spire B, Roux P, Carrieri PM. Suicidal risk among patients enrolled in methadone maintenance treatment: HCV status and implications for suicide prevention (ANRS Methaville). Compr Psychiatry 2015; 62:123-31. [PMID: 26343476 DOI: 10.1016/j.comppsych.2015.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 06/26/2015] [Accepted: 07/07/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Suicide is a critical issue among opioid users. The aim of this study was to assess the relationship between HCV status and suicidal risk in patients receiving methadone treatment. METHODS We used data from Methaville, a multicenter, pragmatic randomized trial designed to evaluate the feasibility of methadone induction in primary care compared with induction in specialized centers. Suicidal risk was assessed at enrollment and after one year of methadone treatment using the suicidality module in the MINI International Neuropsychiatric Interview. Socio-demographic characteristics, drug and alcohol consumption, behavioral and personality factors, history of drug use and health indicators were also assessed. RESULTS A total of 195 individuals were enrolled from January 2009 to December 2010. Suicidal risk assessment was available at month 0 (M0) and M12 for 159 (72%) and 118 (73%) individuals, respectively. Forty-four (28%) were at risk of suicide at M0 and 17 (14%) at M12 (p=0.004). One patient attempted suicide by overdose during the one-year follow-up. The following three factors were associated with suicidal risk: hepatitis C virus (HCV) positive status (OR [95%CI]=17.25 [1.14-161.07]; p=0.04), receiving food assistance (OR [95%CI]=0.05 [0.00-1.05]; p=0.05) and a higher number of health problems (OR [95%CI]=1.24 [1.08-1.44]; p=0.003). CONCLUSIONS Special attention should be given to HCV-positive patients through suicidal risk prevention strategies and routine suicide assessment as part of a comprehensive approach to prevention and care for opioid users. Our results represent a new and powerful argument for the expansion of access to HCV treatment to drug users with chronic infection.
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Affiliation(s)
- Laurent Michel
- Health and Medical Research National Institute, Research Unit 669, Paris, France; University Paris-Sud and University Paris Descartes, UMRS0669, Paris, France; Centre Pierre Nicole, French Red Cross, 27 rue Pierre Nicole, Paris, France.
| | - Caroline Lions
- INSERM, UMR912 "Economics and Social Sciences Applied to Health and Analysis of Medical Information" (SESSTIM), 13006 Marseille, France; Aix Marseille University, UMRS912, IRD, 13006 Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 23 rue Stanislas Torrents, 13006 Marseille, France
| | - Gwenaelle Maradan
- INSERM, UMR912 "Economics and Social Sciences Applied to Health and Analysis of Medical Information" (SESSTIM), 13006 Marseille, France; Aix Marseille University, UMRS912, IRD, 13006 Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 23 rue Stanislas Torrents, 13006 Marseille, France
| | - Marion Mora
- INSERM, UMR912 "Economics and Social Sciences Applied to Health and Analysis of Medical Information" (SESSTIM), 13006 Marseille, France; Aix Marseille University, UMRS912, IRD, 13006 Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 23 rue Stanislas Torrents, 13006 Marseille, France
| | - Fabienne Marcellin
- INSERM, UMR912 "Economics and Social Sciences Applied to Health and Analysis of Medical Information" (SESSTIM), 13006 Marseille, France; Aix Marseille University, UMRS912, IRD, 13006 Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 23 rue Stanislas Torrents, 13006 Marseille, France
| | - Alain Morel
- Oppelia, 20 Avenue Daumesnil, 7512 Paris, France
| | - Bruno Spire
- INSERM, UMR912 "Economics and Social Sciences Applied to Health and Analysis of Medical Information" (SESSTIM), 13006 Marseille, France; Aix Marseille University, UMRS912, IRD, 13006 Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 23 rue Stanislas Torrents, 13006 Marseille, France
| | - Perrine Roux
- INSERM, UMR912 "Economics and Social Sciences Applied to Health and Analysis of Medical Information" (SESSTIM), 13006 Marseille, France; Aix Marseille University, UMRS912, IRD, 13006 Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 23 rue Stanislas Torrents, 13006 Marseille, France
| | - Patrizia M Carrieri
- INSERM, UMR912 "Economics and Social Sciences Applied to Health and Analysis of Medical Information" (SESSTIM), 13006 Marseille, France; Aix Marseille University, UMRS912, IRD, 13006 Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 23 rue Stanislas Torrents, 13006 Marseille, France
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Grebely J, Robaeys G, Bruggmann P, Aghemo A, Backmund M, Bruneau J, Byrne J, Dalgard O, Feld JJ, Hellard M, Hickman M, Kautz A, Litwin A, Lloyd AR, Mauss S, Prins M, Swan T, Schaefer M, Taylor LE, Dore GJ. Recommendations for the management of hepatitis C virus infection among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:1028-38. [PMID: 26282715 PMCID: PMC6130980 DOI: 10.1016/j.drugpo.2015.07.005] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 06/30/2015] [Accepted: 07/07/2015] [Indexed: 02/07/2023]
Abstract
In high income countries, the majority of new and existing hepatitis C virus (HCV) infections occur among people who inject drugs (PWID). In many low and middle income countries large HCV epidemics have also emerged among PWID populations. The burden of HCV-related liver disease among PWID is increasing, but treatment uptake remains extremely low. There are a number of barriers to care which should be considered and systematically addressed, but should not exclude PWID from HCV treatment. The rapid development of interferon-free direct-acting antiviral (DAA) therapy for HCV infection has brought considerable optimism to the HCV sector, with the realistic hope that therapeutic intervention will soon provide near optimal efficacy with well-tolerated, short duration, all oral regimens. Further, it has been clearly demonstrated that HCV treatment is safe and effective across a broad range of multidisciplinary healthcare settings. Given the burden of HCV-related disease among PWID, strategies to enhance HCV assessment and treatment in this group are urgently needed. These recommendations demonstrate that treatment among PWID is feasible and provide a framework for HCV assessment and care. Further research is needed to evaluate strategies to enhance testing, linkage to care, treatment, adherence, viral cure, and prevent HCV reinfection among PWID, particularly as new interferon-free DAA treatments for HCV infection become available.
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Affiliation(s)
| | - Geert Robaeys
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Genk, Belgium; Department of Hepatology, UZ Leuven, Leuven, Belgium; Faculty of Medicine and Life Sciences, Limburg Clinical Research Program, Hasselt University, Hasselt, Belgium
| | | | - Alessio Aghemo
- A.M. Migliavacca Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Markus Backmund
- Ludwig-Maximilians-University, Munich, Germany; Praxiszentrum im Tal Munich, Munich, Germany
| | | | - Jude Byrne
- International Network of People who Use Drugs, Canberra, Australia
| | - Olav Dalgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
| | | | - Margaret Hellard
- Burnet Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Matthew Hickman
- School of Social & Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Achim Kautz
- European Liver Patients Association, Cologne, Germany
| | - Alain Litwin
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States
| | - Andrew R Lloyd
- Inflammation and Infection Research Centre, School of Medical Sciences, UNSW Australia, Sydney, Australia
| | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Düsseldorf, Germany
| | - Maria Prins
- Department of Research, Cluster Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands; Department of Internal Medicine, CINIMA, Academic Medical Centre, Amsterdam, The Netherlands
| | - Tracy Swan
- Treatment Action Group, New York, United States
| | - Martin Schaefer
- Department of Psychiatry, Psychotherapy and Addiction Medicine, Kliniken Essen-Mitte, Essen, Germany; Department of Psychiatry and Psychotherapy-CCM, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lynn E Taylor
- Department of Medicine, Brown University, Providence, RI, United States
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Marco A, Antón JJ, Trujols J, Saíz de la Hoya P, de Juan J, Faraco I, Caylà JA. Personality disorders do not affect treatment outcomes for chronic HCV infection in Spanish prisoners: the Perseo study. BMC Infect Dis 2015; 15:355. [PMID: 26286450 PMCID: PMC4545785 DOI: 10.1186/s12879-015-1102-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 08/12/2015] [Indexed: 12/26/2022] Open
Abstract
Background The link between infection with hepatitis C virus (HCV) and personality disorders (PD) has not been investigated in detail. The aim of this study was to compare the effectiveness of HCV treatment in prisoners with and without PD. Methods We performed a prospective multicentre study in inmates from 25 Spanish prisons who had been treated with pegylated interferon alfa-2a plus ribavirin in 2011. PD diagnosis was based on the Personality Diagnostic Questionnaire-4+. We calculated adjusted Odds Ratios (AOR) and 95 % confidence intervals (95 % CI) using logistic regression. Results The sample included 236 patients (mean age: 40.3 years, 92.8 % male, 79.2 % intravenous drug users, and 26.3 % HIV-coinfected). The prevalence of PD was 72.5 %. 32.2 % of patients discontinued treatment; this percentage was higher in patients with HCV genotypes 1/4 (AOR = 3.55; CI:1.76–7.18) and those without PD (AOR = 2.51; 1.23–5.11). Treatment discontinuation was mainly for penitentiary reasons (40.3 %): release or transfer between prisons. The rate of sustained viral response (SVR) was 52.1 % by ITT and 76.9 % by observed treatment (OT). SVR was higher among patients with genotype 2 or 3, and those with low baseline HCV-RNA. We did not observe any differences between individuals with and without PD in term of SVR, HCV genotype or HIV infection. Conclusions Our results support the safety and clinical effectiveness of the treatment of chronic HCV infection in correctional facilities, both in prisoners with PD and those without. Our data support non-discrimination between patients with and without PD when offering treatment for HCV infection to prison inmates. Trial registration Trial registration number (TRN) NCT01900886. Date of registration: July 8, 2013
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Affiliation(s)
- Andrés Marco
- Barcelona Men's Penitentiary Health Services, Barcelona, Spain. .,CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
| | - José J Antón
- Albolote Penitentiary Health Services, Granada, Spain.
| | - Joan Trujols
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), CIBER Salud Mental (CIBERSAM), Barcelona, Spain.
| | | | - José de Juan
- Córdoba Penitentiary Health Services, Córdoba, Spain.
| | | | - Joan A Caylà
- CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain. .,Epidemiology Service, Barcelona Public Health Agency, Plaza Lesseps 1, 08023, Barcelona, Spain.
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Alavi M, Spelman T, Matthews GV, Haber PS, Day C, van Beek I, Walsh N, Yeung B, Bruneau J, Petoumenos K, Dolan K, Kaldor JM, Dore GJ, Hellard M, Grebely J. Injecting risk behaviours following treatment for hepatitis C virus infection among people who inject drugs: The Australian Trial in Acute Hepatitis C. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:976-83. [PMID: 26115881 DOI: 10.1016/j.drugpo.2015.05.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 04/16/2015] [Accepted: 05/07/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND A barrier to hepatitis C virus (HCV) treatment among people who inject drugs (PWID) has been a concern that interferon-based HCV treatment may increase injecting risk behaviours. This study evaluated recent (past month) injecting risk behaviours during follow-up among PWID that did and did not receive HCV treatment. METHODS The Australian Trial in Acute Hepatitis C (ATAHC) was a prospective study of natural history and treatment of recent HCV infection. Analyses were performed using generalized estimating equations. RESULTS Among 124 participants with a history of injecting drug use (median age 32 years), 69% were male, and 68% were treated for HCV infection. HCV treatment was not associated with an increase in recent injecting drug use (adjusted odds ratio (aOR) 1.06, 95% CI 0.93, 1.21) or recent used needle and syringe borrowing during follow-up (aOR 0.99, 95% CI 0.89, 1.08). HCV treatment was associated with a decrease in recent ancillary injecting equipment sharing during follow-up (aOR 0.85, 95% CI 0.74, 0.99). Further, among treated participants who remained in follow-up (n=24), ancillary injecting equipment sharing significantly decreased from 54% at enrolment to 17% during follow-up (P=0.012). CONCLUSIONS HCV treatment was not associated with drug use or used needle and syringe borrowing during follow-up, but was associated with decreased ancillary injecting equipment sharing during follow-up. Programs to enhance HCV assessment and treatment among PWID should be expanded, given that HCV treatment does not lead to increases in injecting risk behaviours and has previously been demonstrated to be safe and effective among PWID.
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Affiliation(s)
- Maryam Alavi
- The Kirby Institute, UNSW Australia, Sydney, Australia.
| | | | | | - Paul S Haber
- Drug Health Services, Central Clinical School (C39), University of Sydney, Sydney, Australia; Central Clinical School, University of Sydney, Sydney, Australia
| | - Carolyn Day
- Central Clinical School, University of Sydney, Sydney, Australia
| | | | - Nick Walsh
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Barbara Yeung
- The Kirby Institute, UNSW Australia, Sydney, Australia
| | - Julie Bruneau
- Centre de Recherche, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
| | | | - Kate Dolan
- National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, Australia
| | - John M Kaldor
- The Kirby Institute, UNSW Australia, Sydney, Australia
| | | | | | - Jason Grebely
- The Kirby Institute, UNSW Australia, Sydney, Australia
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Correlates of dependence and treatment for substance use among people with comorbid severe mental and substance use disorders: findings from the "Psychiatric and Addictive Dual Disorder in Italy (PADDI)" Study. Compr Psychiatry 2015; 58:152-9. [PMID: 25591906 DOI: 10.1016/j.comppsych.2014.11.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 11/26/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE People with severe mental illness (SMI) have often comorbid alcohol and other substance disorders but substantial barriers to addiction care remain. The study is aimed at describing correlates associated with dependence and with treatment for substance use among people with SMI and comorbid substance disorders cared in community mental health teams (CMHTs). METHODS This study capitalized on data from a national survey on comorbid severe mental and substance use disorders, among 2235 subjects in 42 CMHTs nationwide. RESULTS 26% of people with SMI and comorbid misuse suffered from dependence on alcohol and 21% on any other substance. Use of opioids, liver diseases, involvement with criminal justice system, but also area of residence, all were associated with dependence in people with SMI. As regards treatment for substance use, only 50% of comorbid people with SMI were treated by specialist services in the past 12 months. This was associated with opioids and cocaine use, as well as with liver diseases, and involvement with criminal justice. People with schizophrenia and those living in Central and Southern Italy, had the lowest chances to be treated for their comorbid substance use disorder. CONCLUSIONS There are extensive unmet treatment needs among comorbid individuals with SMI. Better integration of substance abuse and mental health care systems, and more effective reciprocal referral procedures, are needed.
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Fragomeli V, Weltman M. Addressing viral hepatitis in the opiate substitution setting: an integrated nursing model of care. J Gastroenterol Hepatol 2015; 30 Suppl 2:6-11. [PMID: 25641224 DOI: 10.1111/jgh.12864] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Despite the availability of effective therapies for hepatitis C virus (HCV) and B virus (HBV), only a minority of infected patients receive treatment. In the general population, morbidity and mortality associated with chronic HCV is now successfully being addressed through the use of antiviral therapy. In Australia, an estimated 41% to 68% of people who inject drugs (PWID) are HCV positive, and between 28% and 59% of users are estimated to have been exposed to HBV. Although current treatment guidelines suggest that active drug use should not preclude people from HCV treatment, uptake of therapy thus far has been low. Patient, physician, social, and logistical-related barriers contribute to the low uptake of HCV treatment among PWID. Traditional means of managing HCV infection—referral to secondary or tertiary health centers—historically has a poor track record in increasing therapy uptake among this population. The same is true for people with chronic HBV who inject drugs. Close to 50,000 Australians receive opioid substitution therapy (OST) through a range of services, including public and private clinics, thus this setting is an ideal target for identifying and treating people at risk for and already infected with HBV and HCV. Over the last 11 years, a nursing model of care initiated by a teaching hospital in Sydney, Australia that integrates viral hepatitis screening, assessment, and treatment into the OST setting has enhanced access to services among the marginalized injecting drug use population.
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Affiliation(s)
- Vince Fragomeli
- Department of Gastroenterology and Hepatology Services, Nepean Hospital, Penrith, New South Wales, Australia
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30
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A longitudinal study evaluating the effects of interferon-alpha therapy on cognitive and psychiatric function in adults with chronic hepatitis C. J Psychosom Res 2015; 78:184-92. [PMID: 25219976 PMCID: PMC4435678 DOI: 10.1016/j.jpsychores.2014.07.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 07/16/2014] [Accepted: 07/29/2014] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To prospectively evaluate for changes in objective cognitive performance (attention, memory, and executive function) and psychiatric symptom severity (depression, anxiety, fatigue, and pain) in patients before, during and after interferon-alpha based therapy (IFN) for chronic hepatitis C virus infection (HCV). METHODS 33 HCV+ adults were evaluated two months before IFN initiation (baseline), three months into IFN, and six months following IFN termination (IFN+ Group). 31 HCV+ adults who did not undergo IFN therapy were evaluated at baseline and six months later (IFN- Group). At each evaluation, participants completed the Neuropsychological Assessment Battery (NAB) Attention, Memory and Executive Functions Modules, the Beck Depression Inventory, Second Edition (BDI), Generalized Anxiety Disorder Inventory (GADI), Fatigue Severity Scale (FSS), and Brief Pain Inventory (BPI). RESULTS Compared with the IFN- Group, the IFN+ Group experienced significantly (p<0.050) increased symptoms of depression, anxiety, fatigue and pain during IFN therapy relative to baseline. In the IFN+ Group, psychiatric symptoms generally returned to baseline levels following IFN termination. Sustained viral response was associated with significantly lower depression and fatigue. No significant changes in cognitive performance were observed. CONCLUSIONS During IFN, patients with HCV evidence significantly increased psychiatric symptoms, including symptoms of depression, anxiety, fatigue and pain. These psychiatric symptoms are generally short-term and remit following IFN termination, with increased benefit if viral clearance is achieved. However, IFN is not associated with significant declines in objective cognitive performance during or following IFN.
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31
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Arain A, Robaeys G. Eligibility of persons who inject drugs for treatment of hepatitis C virus infection. World J Gastroenterol 2014; 20:12722-12733. [PMID: 25278674 PMCID: PMC4177459 DOI: 10.3748/wjg.v20.i36.12722] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 05/19/2014] [Indexed: 02/06/2023] Open
Abstract
In this decade, an increase is expected in end-stage liver disease and hepatocellular carcinoma, most commonly caused by hepatitis C virus (HCV) infection. Although people who inject drugs (PWID) are the major source for HCV infection, they were excluded from antiviral treatments until recently. Nowadays there is incontrovertible evidence in favor of treating these patients, and substitution therapy and active substance use are no longer contraindications for antiviral treatment. The viral clearance in PWID after HCV antiviral treatment with interferon or pegylated interferon combined with ribavirin is comparable to the viral clearance in non-substance users. Furthermore, multidisciplinary approaches to delivering treatment to PWID are advised, and their treatment should be considered on an individualized basis. To prevent the spread of HCV in the PWID community, recent active PWID are eligible for treatment in combination with needle exchange programs and substitution therapy. As the rate of HCV reinfection is low after HCV antiviral treatment, there is no need to withhold HCV treatment due to concerns about reinfection alone. Despite the advances in treatment efficacies and data supporting their success, HCV assessment of PWID and initiation of antiviral treatment remains low. However, the proportion of PWID assessed and treated for HCV is increasing, which can be further enhanced by understanding the barriers to and facilitators of HCV care. Removing stigmatization and implementing peer support and group treatment strategies, in conjunction with greater involvement by nurse educators/practitioners, will promote greater treatment seeking and adherence by PWID. Moreover, screening can be facilitated by noninvasive methods for detecting HCV antibodies and assessing liver fibrosis stages. Recently, HCV clearance has become a major endpoint in the war against drugs for the Global Commission on Drug Policy. This review highlights the most recent evidence concerning HCV infection and treatment strategies in PWID.
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Grebely J, Bruggmann P, Backmund M, Dore GJ. Moving the agenda forward: the prevention and management of hepatitis C virus infection among people who inject drugs. Clin Infect Dis 2014; 57 Suppl 2:S29-31. [PMID: 23884062 DOI: 10.1093/cid/cit264] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Robaeys G, Grebely J, Mauss S, Bruggmann P, Moussalli J, De Gottardi A, Swan T, Arain A, Kautz A, Stöver H, Wedemeyer H, Schaefer M, Taylor L, Backmund M, Dalgard O, Prins M, Dore GJ. Recommendations for the management of hepatitis C virus infection among people who inject drugs. Clin Infect Dis 2014; 57 Suppl 2:S129-37. [PMID: 23884061 DOI: 10.1093/cid/cit302] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In the developed world, the majority of new and existing hepatitis C virus (HCV) infections occur among people who inject drugs (PWID). The burden of HCV-related liver disease in this group is increasing, but treatment uptake among PWID remains low. Among PWID, there are a number of barriers to care that should be considered and systematically addressed, but these barriers should not exclude PWID from HCV treatment. Furthermore, it has been clearly demonstrated that HCV treatment is safe and effective across a broad range of multidisciplinary healthcare settings. Given the burden of HCV-related disease among PWID, strategies to enhance HCV assessment and treatment in this group are urgently needed. These recommendations demonstrate that treatment among PWID is feasible and provides a framework for HCV assessment, management, and treatment. Further research is needed to evaluate strategies to enhance assessment, adherence, and SVR among PWID, particularly as new treatments for HCV infection become available.
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Affiliation(s)
- Geert Robaeys
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Genk, Belgium.
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