Emcdda Documentation Centre s5

EMCDDA DOCUMENTATION CENTRE INFORMATION BULLETIN

INFECTIOUS DISEASES

29 April 2016 ______

JOURNAL ARTICLES – Hepatitis

Treatment for chronic hepatitis C in a cohort of opiate substitution therapy recipients in three Swedish cities – completion rates and efficacy Jerkeman A, Norkrans G, Lidman C, Westin J, Lagging M, Frimand J, Simonsberg C, Kakko J, Widell A, Björkman P European Journal of Gastroenterology and Hepatology 26 (5) p.523-31, 2014

Objectives: Opiate substitution treatment (OST) programs could provide opportunities for management of comorbidities, such as hepatitis C virus (HCV) infection, in people who inject drugs. We aimed to prospectively evaluate the real-life feasibility of interferon/ribavirin-based HCV treatment in OST recipients, with a special focus on psychiatric status and health-related quality of life. Methods: Patients from a cohort of OST recipients from three cities in Sweden were selected for HCV treatment on the basis of structured investigation for HCV-related liver disease. Therapy was delivered in collaboration between infectious disease and OST clinics, with monitoring for completion and adherence, treatment response, adverse events, health-related quality of life (HRQoL) (SF-36) and signs of depression (MADRS-S), or relapse into drug abuse. The primary endpoint was completion of prescribed treatment; the secondary endpoints were sustained virological response (SVR), adherence, and incidence of depression. Results: Among 69 patients with an indication for antiviral therapy, 41 initiated treatment; 34/41 (83%) completed treatment and 19/41 (46%) achieved SVR. Adequate adherence was observed in 29/41 patients (71%). Two serious adverse events occurred, including one death because of liver failure. Baseline scores for self-assessed health were low, with a significant reduction during treatment. Seventy-one percent of patients (29/41) fulfilled the criteria for clinically significant depression at some time point during treatment. Baseline scores for HRQoL/MADRS-S were associated with treatment completion, SVR, and depression during treatment. Conclusion: Despite the low HRQoL and the high occurrence of depression, HCV treatment was feasible and showed satisfactory rates of completion in this cohort of unselected OST recipients.

JOURNAL ARTICLES – HIV/AIDS A 6-month follow-up of the integrated treatment for opiate addiction and HIV in Vietnam C. Denis, D. Metzger, L. Huang, V. Trias, M. Auriacombe, G. Raguin, S. Mai Thi Hoai, G. Le Truong, J-P. Daulouède, C. O’Brien

Background: There is a lack of access to comprehensive treatment for both opiate use disorder and HIV in Vietnam. Less than 10% of opiate users are currently in treatment and among HIV-positive patients, less than 70% received antiretroviral therapy (ARV). Since November 2013, we have implemented an integrated drug treatment program within an HIV treatment setting in Ho Chi Minh City, Vietnam. Methods: All the patients received opiate maintenance treatment (methadone or buprenorphine/naloxone), HIV and HCV testing and counseling sessions focused on substance use and HIV/ HCV risk-taking behaviors. Here we assess the impact of this program on treatment initiation, treatment adherence, and change in substance use at 6-month follow-up. Results: Since December-01-2013, 145 heroin injectors who met DSM-5 opiate use disorder diagnosis were enrolled. None of the patients who sought treatment at Go Vap clinic refused to participate. They were mainly males (96.4%), 32.4 y.o. (SD= 5.2), living with family (81%), reporting employment (50.4%). They reported using heroin for an average of 7.8 years (SD= 3.6, min-max= 1-20). The retention rate at 6-month was 96.6%, significantly higher than before the initiation of the integrated treatment program (86.3%). Treatment adherence was very high, 90.3% did not miss any methadone doses, 6 patients missed only one day of treatment. The methadone maintenance dose ranged from 30 mg to 220 mg per day. The counseling session attendance ranged from 83% to 100%, and none of the participants missed more than one counseling session. There was a significant decrease in opioid (heroin) use, 68% of the participants reported using heroin at 1 month, 13% at 2 months and none after 3 months of treatment. Fifty-one (35.2%) were HIV-positive, with four not previously known to be positive. All 51 HIV-positive participants received HIV treatment. Eighty- nine (68.0%) were HCV-positive, 42 (46.7%) were newly diagnosed. Only 2 participants (2.4%) had received HCV treatment. Conclusion: At 6-month, the findings showed the added value of an integrated treatment program on drug use, HIV detection, and access to HIV care. Long-term follow-up is needed to confirm the impact of this program.

Socioeconomic marginalization and plasma HIV-1 RNA nondetectability among individuals who use illicit drugs in a Canadian setting Richardson LA, Kerr TH, Dobrer S, Puskas CM, Guillemi SA, Montaner JS, Wood E, Milloy MJ AIDS 29 (18) p.2487-95, 2015

Objective: Given that people who use illicit drugs (PWUD) often engage in prohibited income generation to support their basic needs, we sought to examine the role of these activities in shaping antiretroviral therapy (ART) adherence and plasma HIV RNA-1 viral load suppression among HIV-infected PWUD. Design: Longitudinal analyses among HIV-positive, ART-exposed PWUD in the AIDS Care Cohort to evaluate Exposure to Survival Services prospective cohort study (2005- 2013). Methods: Generalized linear mixed-effects and mediation analyses examined the relationship between prohibited income generation (e.g., sex work, drug dealing, theft, street-based income) and virologic suppression (plasma viral load ?50 copies/ml plasma) adjusting for adherence and potential confounders. Results: Among 687 HIV-infected PWUD, 391 (56.9%) individuals reported prohibited income generation activity during the study period. In multivariate analyses, prohibited income generation remained independently and negatively associated with virologic suppression (adjusted odds ratio: 0.68, 95% confidence interval: 0.52-0.88) following adjustment for hypothesized confounders, including high-intensity drug use, ART adherence and homelessness. Although partially mediated by ART adherence, the relationship between prohibited income generation and virologic suppression was maintained in mediation analyses (Sobel statistic = -1.95, P = 0.05). Conclusion: Involvement in prohibited income generation decreases the likelihood of virologic suppression directly and indirectly through its negative association with ART adherence. These findings suggest that linkages between socioeconomic marginalization, the criminalization of illicit drug use, and insufficient employment opportunities may produce barriers to access and retention in care. Programmatic and policy interventions that decrease socioeconomic vulnerability may therefore reduce HIV-related morbidity, mortality, and onward transmission.

Prevalence and correlates of HIV risk among adolescents and young adults reporting drug use: Data from an urban emergency department in the United States Bonar EE, Whiteside LK, Walton MA, Zimmerman MA, Booth BM, Blow FC, Cunningham R Journal of HIV/AIDS & Social Services 28, 2, p.625-630, 2014

Adolescents and young adults who use substances are at particularly high risk for contracting Human Immunodeficiency Virus (HIV). The Emergency Department (ED) is a critical location for HIV prevention for at-risk youth. To inform future interventions in the ED, this study identifies correlates of HIV risk behaviors among substance using youth seeking ED care. Among 600 14-24-year-olds with past 6-month drug use, bivariate correlates of HIV risk included: older age, female gender, depressive symptoms, alcohol use, marijuana use, other drug use, and dating, peer, and community violence. Regression analyses indicated that older age, marijuana use, and dating violence were positively related to HIV risk. Results suggest HIV prevention efforts for youth in the urban ED should address marijuana use and dating violence as well as sexual risk behaviors. [FULL TEXT AVAILABLE] Loneliness and substance use: the influence of gender among HIV+ Black/African American adults 50+ Mannes, Z L et al AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV 28, 5, p.598-602, 2016

Estimates suggest 30% of adults report the highest levels of loneliness. Though men are more likely than women to use illicit substances and engage in heavy drinking, the prevalence of substance use in women is growing and their escalation toward dependence occurs more rapidly. Loneliness and substance use have greater relevance within the HIV+ population, with higher rates of substance misuse than the general population. However, the association between loneliness and substance use within HIV+ individuals remains understudied. The purpose of the present study was to test the hypothesis that there would be an association between loneliness and substance moderated by gender in HIV+ older adults. A cross-sectional study was conducted between October 2013 and January 2014. Study participants included 96 HIV-positive Black/African American men and women recruited through the University of Florida Center for HIV/AIDS Research, Education and Service (UF CARES) in Jacksonville, Florida. Participants completed an interviewer-administered assessment examining mental and behavioral health. Pearson correlations examined associations between loneliness and substance use. Binary logistic regression analyses stratified by gender examined the association between loneliness and substance use while controlling for covariates. Among women, loneliness was associated with illicit drug use, AOR = 3.37, 95% CI: 1.23–9.21, p = .018 and heavy drinking, AOR = 2.47, 95% CI: 1.07–5.71, p = .033. No significant associations were found between loneliness and illicit drug use, and heavy drinking in men. Substance use among women in this population may be linked to loneliness. Interventions should be gender specific. Further research into this association is necessary as it will likely have important clinical implications for this population.

Male-to-male sexual transmission of Zika virus — Texas, January 2016 http://www.cdc.gov/mmwr/volumes/65/wr/mm6514a3.htm?s_cid=mm6514a3_e

Warnings over five-fold increase in HIV in Glasgow area Health officials in the Glasgow area have warned people who inject drugs about an outbreak of HIV after a near five-fold increase in the city | BBC, UK http://www.bbc.co.uk/news/uk-scotland-glasgow-west-36062132