DISCLOSURES January 23, 2018
Effective antiretroviral treatments for HIV and hepatitis C exist and are widely available. In fact, treatment for hepatitis C is curative, which hardly seemed imaginable only a few short years ago. But despite there being effective treatments for these diseases, barriers exist that make their treatment difficult. Chief among these barriers is intravenous use of opioids.
The stark reality is that people with hepatitis C or HIV, or both diseases, are much more likely to die of drug overdose than of chronic illness itself. Furthermore, according to the Centers for Disease Control and Prevention, in 2014 death from drug overdose was more common than death caused by motor vehicle accidents or firearms. Of note, 80% of people who inject drugs and are HIV-positive also have hepatitis C.
At IDWeek 2017, managing infectious disease in opioid users was an important topic of coverage. In a lecture titled "Co-management of Opioid Treatment, HIV, and Hepatitis C Treatment," Brianna Norton, DO, MPH, an assistant professor of infectious disease and internal medicine at the Albert Einstein College of Medicine, discussed evidence-based approaches to treating opioid use disorder in patients with HIV and hepatitis C.
The Austin, Indiana, OutbreakIn late 2014, an HIV outbreak was centered on a small rural town called Austin, in Scott County, Indiana. Austin is about 80 miles southeast of Indianapolis. Although Austin has a population of approximately 4200, by June 2015, 170 people had been diagnosed with HIV infection. To put this number in perspective, during the 10 years before the outbreak, only 5 people had been diagnosed with HIV in Scott County.
In a 2016 article titled "HIV Transmission and Injection Drug Use: Lessons From the Indiana Outbreak," Diane M. Janowicz, MD, attributed this HIV outbreak to injection drug use. "It is estimated that there were more than 500 syringe-sharing partners in Scott County. Injection practices were multigenerational and injection equipment was commonly shared. Individuals diagnosed with HIV infection during the outbreak had an average of nine high-risk syringe-sharing, sex, or social partners who needed to be tested for infection. The drug most commonly used was oxymorphone, in a reformulation available since 2012, which was crushed and injected. Oxymorphone produces a fixed but short-lived high, and individuals may inject the substance as many as 20 times per day."
TO CONTINUE ARTICLE: https://www.medscape.com/viewarticle/891282