Psychoeducation Improves Hepatitis C Virus Treatment During Opioid Substitution Therapy: A Controlled, Prospective Multicenter Trial.

Psychoeducation improves hepatitis C virus treatment during opioid substitution therapy: a controlled, prospective multicenter trial.

Clin Infect Dis. 2013 Aug; 57 Suppl 2: S97-S104
Reimer J, Schmidt CS, Schulte B, Gansefort D, Gölz J, Gerken G, Scherbaum N, Verthein U, Backmund M

Background.?People who inject drugs (PWID) have a high prevalence of hepatitis C virus (HCV) infection. However, PWID are considered “difficult to treat,” requiring a specifically adapted treatment setting, including psychosocial support. Methods.?In this prospective, German trial, the impact of psychoeducation (PE) on retention and sustained virologic response (SVR) during HCV therapy among PWID was evaluated. We included 198 patients in opiate substitution therapy, who fulfilled indications for antiviral treatment. All patients received pegylated interferon alfa-2a and ribavirin therapy. Patients in the intervention group (n = 82) received manualized PE sessions. Results.?In patients with HCV genotype 1 or 4 (GT 1/4), PE was associated with increased treatment completion (76% vs 55%, P = .038), whereas PE had no such effect among GT 2/3 patients, who showed fewer dropouts and higher SVR rates. Among GT 1/4 patients, a minimum of 5 PE sessions was associated with increased SVR (71% vs 48%, P = .037). Multivariate regression analyses confirmed the impact of PE in GT 1/4 and revealed further predictors for retention and SVR, such as preexisting mental distress and adverse events. Conclusions.?In patients with a higher risk of dropout due to GT 1/4 or mental distress, PE was shown to improve retention and SVR. PE is an effective supportive intervention for HCV therapy among PWID. Clinical Trials Registration.?NCT00844272. HubMed – addiction

Models of care for the management of hepatitis C virus among people who inject drugs: one size does not fit all.

Clin Infect Dis. 2013 Aug; 57 Suppl 2: S56-61
Bruggmann P, Litwin AH

One of the major obstacles to hepatitis C virus (HCV) care in people who inject drugs (PWID) is the lack of treatment settings that are suitably adapted for the needs of this vulnerable population. Nevertheless, HCV treatment has been delivered successfully to PWID through various multidisciplinary models such as community-based clinics, substance abuse treatment clinics, and specialized hospital-based clinics. Models may be integrated in primary care-all under one roof in either addiction care units or general practitioner-based models-or can occur in secondary or tertiary care settings. Additional innovative models include directly observed therapy and peer-based models. A high level of acceptance of the individual life circumstances of PWID rather than rigid exclusion criteria will determine the level of success of any model of HCV management. The impact of highly potent and well-tolerated interferon-free HCV treatment regimens will remain negligible as long as access to therapy cannot be expanded to the most affected risk groups. HubMed – addiction

Drug-drug interactions in the treatment of HCV among people who inject drugs.

Clin Infect Dis. 2013 Aug; 57 Suppl 2: S125-8
Mauss S, Klinker H

Boceprevir and telaprevir are inhibitors and substrates of the cytochrome P450 3A4 family. With the use of these HCV protease inhibitors as part of standard therapy for chronic hepatitis C genotype 1 infection, drug-drug interactions with multiple medications being inductors, inhibitors, or substrates of cytochrome P450 3A4 can be expected. Due to the complexity of these interactions, predicting the expected magnitude and sometimes even the direction of the effect has proven to be difficult. Pharmacokinetic studies should be carried out to evaluate drugs with clinical relevance and possible interactions. This review focuses on the data available regarding drugs that are frequently used in the setting of addiction or used by patients with addiction. In addition to highlighting relevant drug-drug interactions, alternative drugs that can be safely used are suggested. HubMed – addiction

Management of Hepatitis C Virus/HIV Coinfection Among People Who Use Drugs in the Era of Direct-Acting Antiviral-Based Therapy.

Clin Infect Dis. 2013 Aug; 57 Suppl 2: S118-24
Taylor LE, Swan T, Matthews GV

Where active antiretroviral therapy (ART) is accessible, human immunodeficiency virus (HIV) is a survivable illness and effective ART can reduce HIV transmission. Chronic hepatitis C virus (HCV) has emerged as a threat to the survival of individuals harboring both HCV and HIV, due to high prevalence and aggressive disease course. The HCV/HIV coinfection epidemic has been driven by people who inject drugs (PWID), although incident HCV is rising among HIV-infected men who have sex with men in the absence of drug injection. Coinfected individuals warrant aggressive treatment of both viruses; although early ART initiation is recommended to reduce the rate of liver disease progression, the most effective way to decrease HCV-related morbidity and mortality in coinfection is to achieve HCV viral eradication. Direct-acting antiviral (DAA) agents will soon revolutionize HCV treatment. Clinical data are needed regarding the efficacy of DAAs in coinfected PWID. Drug-drug interaction studies between ART, DAAs, and opiate substitution therapy must be expedited. Coinfected PWID should have equitable and universal access to HIV/AIDS, HCV, and addiction prevention, care, and treatment. Essential basic steps include improving screening for both infections and engaging coinfected PWID in HIV and HCV care early after diagnoses. Developing strategies to expand access to HCV therapy for coinfected PWID is imperative to stem the HCV epidemic and limit the morbidity and mortality of those at greatest risk for HCV disease progression. The ultimate goal must be the elimination of HCV from all coinfected PWID. HubMed – addiction

Management of mental health problems prior to and during treatment of hepatitis C virus infection in patients with drug addiction.

Clin Infect Dis. 2013 Aug; 57 Suppl 2: S111-7
Schaefer M, Sarkar R, Diez-Quevedo C

Psychiatric comorbidity is a common problem in patients with substance use disorders. Patients with psychiatric diseases and/or substance abuse have an increased risk for hepatitis C virus (HCV) infection. Furthermore, psychiatric problems occur frequently during antiviral treatment and may be associated with the use of interferon alpha (IFN-?) but also with the primary psychiatric condition. As a consequence, substance abuse and/or acute psychiatric problems are still important reasons for nontreatment of chronic HCV infection. However, prospective and controlled data from recent years showed that if an interdisciplinary treatment is provided, patients with substance use disorders and/or psychiatric diseases do not differ regarding sustained virologic response or IFN-?-associated complications such as depression when compared with controls. Moreover, depression as the most important acute IFN-?-associated psychiatric adverse event can be acutely treated or even prevented by antidepressant pretreatment. Other, more rare but severe complications such as mania, psychotic symptoms, or delirium need individual psychiatric interventions. HubMed – addiction

Illinois Addiction Rehab Programs 1 800 303 2938
Subscribe the channel more Rehab Videos. Tag:alcohol rehab, rehab centers, rehab facilities, rehab for alcoholics, dru…