​Monday, January 29, 2018-Medscape
​COMMENTARY

​Naveed Saleh, MD, MS
DISCLOSURES January 23, 2018

​Infection and Opioids

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.[1]
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.[2]
In a 2016 article titled "HIV Transmission and Injection Drug Use: Lessons From the Indiana Outbreak," Diane M. Janowicz, MD,[2] 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

Gail Connor Roche
Publish Date: Monday, January 22, 2018

.As many as three-quarters of individuals with hepatitis C virus (HCV) experience disorders related to the virus beyond the impact on their livers, the National Viral Hepatitis Roundtable estimates.

HCV-related kidney disease, depression, skin disorders, lymphoma and other conditions can seriously impact a patient, even without severe damage to the liver, studies have shown. There’s also growing evidence as to how HCV intersects with other disease states, Tina Broder, MSW, MPH, Program Director of NVHR, told MD Magazine. 

 “Our hope in highlighting the extrahepatic manifestations of HCV is to show that curing HCV patients may help improve health conditions beyond liver function,” Broder said.

To publicize that point, NVHR is creating a campaign aimed at both clinicians and patients that emphasizes the importance of managing the virus as a system-wide condition. The group is distributing informational “fact sheets” produced from a review of scientific research and input from staff and a clinical consultant with expertise in HCV. The aim is to help make a business case for treating patients regardless of the severity of their liver disease and to broaden treatment access, Broder said.
           
As many as 3.9 million people in the US have chronic HCV, the US Centers for Disease Control and Prevention (CDC) estimates. Of every 100 individuals infected with the virus, 75 to 85 of them will develop chronic HCV. Five to 20 of these patients will progress to cirrhosis in 20 to 30 years. As many as 5 will die from cirrhosis or liver cancer, the CDC estimates.
           
Hepatitis C-related effects on parts of the body besides the liver can be an early indicator of HCV infection, NVHR says. And the virus may be driving other chronic conditions that primary care providers must spend their time managing.
           
“The evidence showing that HCV infection is a risk factor for other health conditions continues to grow,” Broder said. “Concurrently, research is beginning to show that in the era of direct acting antivirals (DAAs), early HCV treatment can cure and possibly prevent the development of extrahepatic manifestations associated with HCV.”
​
​TO CONTINUE READING: 
https://www.specialtypharmacytimes.com/news/growing-evidence-shows-hepatitis-c-intersects-with-other-diseases


This article was originally published by MD Magazine.

NVHR

More than 60 organizations, including NVHR, signed onto a letter urging the Trump administration to invest in the Department of Health & Human Services Viral Hepatitis Action Plan and to commit in words and action to the elimination of HBV and HCV in the United States by 2030. You may download a copy of the letter here.


http://nvhr.org/content/america-falling-behind-hepatitis-elimination-efforts
​

December 28, 2017, 6:55 pm  Perry Smith THE SIGNAL

Less than 10 days before Christmas, another Santa Clarita Valley family lost a son to the heroin epidemic.
It wasn’t an overdose, but a growing concern that’s associated with the drug epidemic. The 29-year-old died of endocarditis, which, like the Hepatitis B he’d also contracted, was brought on by intravenous drug use.
He’d been arrested several times, and like many who are addicted to drugs in the Santa Clarita Valley, he was known to the Santa Clarita Valley Sheriff’s Station’s Juvenile Intervention Team, or J-Team, which had tried repeatedly to get him into a rehab program.
“In June, I had contacted the guy and he was very cordial, we had a very cordial conversation and I offered him our help in finding a drug counseling program that would fit his financial situation,” said Sgt. Bob Wachsmuth, a drug addiction specialist and member of the Santa Clarita Valley Sheriff’s Station’s Juvenile-Intervention Team, or J-Team. “And he said he would get back to me.”
Relapses and repeated use bring with them a myriad of concerns and medical problems beyond the deadly overdose.
“Using drugs themselves, obviously are pretty dangerous,” said Dr. Darrin Privett, an emergency room doctor for Henry Mayo Newhall Hospital, “but on top of that there’s a host of complication that can make that even more dangerous.”
The most common things that emergency room doctors see are the painful infections that addicts can get from intravenous drug use, he said.
“Most commonly they get local abscesses where they inject in the skin,” he said. “The veins themselves get inflamed and scarred.. and then there are other associated diseases, such as Hepatitis B, Hepatitis C and HIV.”
Studies have shown that 75 percent to 90 percent of people who inject drugs have Hepatitis C, he pointed out.

​TO CONTINUE READING: https://signalscv.com/2017/12/beyond-overdose-addictions-deadly-side-effects/​