In the Journals

Experts: We must increase access to HCV treatment for substance users

In a recent editorial, experts discussed the necessity to optimize control and treatment of hepatitis C among patients with substance abuse disorders, to further the goal of HCV elimination.

“Since the initial discovery of HCV infection, development of tolerable antiviral therapies has revolutionized its treatment,” Andrew H. Talal, MD, MPH, and colleagues wrote. “However, we are far from having won the war against the virus. Entry into HCV care among persons with [substance use disorders] unfortunately remains severely restricted, largely because of their inability to access appropriate HCV management.”

According to Talal and colleagues, patients with substance use disorders account for 68% to 80% of infections in developed countries and there has been a recent sharp increase in HCV incidence among this population.

Access to care and lifestyle complications are two of the major obstacles in optimizing treatment for patients with substance abuse disorders. Physician reluctance to treat substance users, limited access to costly direct-acting antivirals and limited locations for treatment, combined with this population’s often chaotic lifestyles and discomfort encountered at conventional health care settings, are all concerns in developing models of care.

Treatment of HCV in patients with substance use disorders is believed to have potential as a prevention tool. Until studies can prove the effectiveness of this strategy, however, vaccines will be required to curtail viral transmission and limit reinfection, the authors wrote.

Increased options for screening and connection to care will also be required, they added. Integration and collocation of treatment for HCV is a novel approach to reach the substance user population.

“Potential benefits of collocation include medical provider training in delivery of treatment of both HCV infection and [substance use disorders], leverage of intensive psychosocial and peer support programs frequently based in substance use treatment programs, and delivery of all the critical elements of care on site,” the researchers wrote.

Telemedicine or virtual collocation is a part of such an approach. With recent advances in portable devices, such as transient elastography, liver fibrosis can be assessed with high reliability without the limitation of geographical location of physician and patient.

Similar onsite and telemedicine interventions could likewise promote HCV care in the correctional setting, wherein a high percentage of patients with substance use disorders can be found.

Areas of knowledge that are currently limited and require additional study include HCV treatment as prevention, whether point-of-care diagnostics can increase engagement of patients with substance use disorders, effectiveness of telemedicine models in correctional facilities, the effect of DAA treatment on fibrosis regression and on the risk for hepatocellular carcinoma, and reactivation of hepatitis B in this population.

“The Centers for Disease Control and Prevention, National Institutes of Health, and other federal and industrial partners have active research programs designed to engaged HCV-infected persons with SUDs into care,” the researchers concluded. “These research gaps need to be addressed to eliminate HCV infection in this population.” – by Talitha Bennett

Disclosures: Talal reports he has received grant/research support from Merck, Gilead, Abbott, AbbVie, Intercept and Conatusand and has been a consultant/advisor for Merck, Abbott Diagnostics, AbbVie and Chronic Liver Disease Foundation. Please see the full study for the other researchers’ relevant financial disclosures.

In a recent editorial, experts discussed the necessity to optimize control and treatment of hepatitis C among patients with substance abuse disorders, to further the goal of HCV elimination.

“Since the initial discovery of HCV infection, development of tolerable antiviral therapies has revolutionized its treatment,” Andrew H. Talal, MD, MPH, and colleagues wrote. “However, we are far from having won the war against the virus. Entry into HCV care among persons with [substance use disorders] unfortunately remains severely restricted, largely because of their inability to access appropriate HCV management.”

According to Talal and colleagues, patients with substance use disorders account for 68% to 80% of infections in developed countries and there has been a recent sharp increase in HCV incidence among this population.

Access to care and lifestyle complications are two of the major obstacles in optimizing treatment for patients with substance abuse disorders. Physician reluctance to treat substance users, limited access to costly direct-acting antivirals and limited locations for treatment, combined with this population’s often chaotic lifestyles and discomfort encountered at conventional health care settings, are all concerns in developing models of care.

Treatment of HCV in patients with substance use disorders is believed to have potential as a prevention tool. Until studies can prove the effectiveness of this strategy, however, vaccines will be required to curtail viral transmission and limit reinfection, the authors wrote.

Increased options for screening and connection to care will also be required, they added. Integration and collocation of treatment for HCV is a novel approach to reach the substance user population.

“Potential benefits of collocation include medical provider training in delivery of treatment of both HCV infection and [substance use disorders], leverage of intensive psychosocial and peer support programs frequently based in substance use treatment programs, and delivery of all the critical elements of care on site,” the researchers wrote.

Telemedicine or virtual collocation is a part of such an approach. With recent advances in portable devices, such as transient elastography, liver fibrosis can be assessed with high reliability without the limitation of geographical location of physician and patient.

Similar onsite and telemedicine interventions could likewise promote HCV care in the correctional setting, wherein a high percentage of patients with substance use disorders can be found.

Areas of knowledge that are currently limited and require additional study include HCV treatment as prevention, whether point-of-care diagnostics can increase engagement of patients with substance use disorders, effectiveness of telemedicine models in correctional facilities, the effect of DAA treatment on fibrosis regression and on the risk for hepatocellular carcinoma, and reactivation of hepatitis B in this population.

“The Centers for Disease Control and Prevention, National Institutes of Health, and other federal and industrial partners have active research programs designed to engaged HCV-infected persons with SUDs into care,” the researchers concluded. “These research gaps need to be addressed to eliminate HCV infection in this population.” – by Talitha Bennett

Disclosures: Talal reports he has received grant/research support from Merck, Gilead, Abbott, AbbVie, Intercept and Conatusand and has been a consultant/advisor for Merck, Abbott Diagnostics, AbbVie and Chronic Liver Disease Foundation. Please see the full study for the other researchers’ relevant financial disclosures.