scholarly journals Predictors of Hepatitis C Treatment Failure After Using Direct-Acting Antivirals in People Living With Human Immunodeficiency Virus

2019 ◽  
Vol 6 (3) ◽  
Author(s):  
Edward R Cachay ◽  
Alvaro Mena ◽  
Luis Morano ◽  
Laura Benitez ◽  
Ivana Maida ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Mental Illness ◽  
Drug Use ◽  
Treatment Failure ◽  
Illicit Drug ◽  
Virologic Failure ◽  
Illicit Drug Use ◽  
Hcv Treatment ◽  
Immunodeficiency Virus ◽  
Direct Acting

Abstract Background Little is known about the influence of ongoing barriers to care in the persistence of hepatitis C virus (HCV) viremia after treatment with direct-acting antivirals (DAAs) among people living with human immunodeficiency virus (PLWH). Methods We conducted a retrospective cohort analysis of PLWH treated through the standard of care in 3 Western countries, to investigate the predictors of HCV treatment failure (clinical or virologic), defined as having a detectable serum HCV ribonucleic acid within 12 weeks after DAA discontinuation. In addition to HCV and liver-related predictors, we collected data on ongoing illicit drug use, alcohol abuse, mental illness, and unstable housing. Logistic regression analyses were used to identify predictors of HCV treatment failure. Results Between January 2014 and December 2017, 784 PLWH were treated with DAA, 7% (n = 55) of whom failed HCV therapy: 50.9% (n = 28) had a clinical failure (discontinued DAA therapy prematurely, died, or were lost to follow-up), 47.3% (n = 26) had an HCV virologic failure, and 1 (1.8%) was reinfected with HCV. Ongoing drug use (odds ratio [OR] = 2.60) and mental illness (OR = 2.85) were independent predictors of any HCV treatment failure. Having both present explained 20% of the risk of any HCV treatment failure due to their interaction (OR = 7.47; P < .0001). Predictors of HCV virologic failure were ongoing illicit drug use (OR = 2.75) and advanced liver fibrosis (OR = 2.29). Conclusions People living with human immunodeficiency virus with ongoing illicit drug use, mental illness, and advanced liver fibrosis might benefit from enhanced DAA treatment strategies to reduce the risk of HCV treatment failure.

scholarly journals Impact of Abstinence and of Reducing Illicit Drug Use Without Abstinence on Human Immunodeficiency Virus Viral Load

2019 ◽  
Vol 70 (5) ◽  
pp. 867-874 ◽  
Author(s):  
Robin M Nance ◽  
Maria Esther Perez Trejo ◽  
Bridget M Whitney ◽  
Joseph A C Delaney ◽  
Fredrick L Altice ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Substance Use ◽  
Viral Load ◽  
Drug Use ◽  
Viral Suppression ◽  
Illicit Drug ◽  
Illicit Drug Use ◽  
Hiv Viral Load ◽  
Immunodeficiency Virus ◽  
The Impact

Abstract Background Substance use is common among people living with human immunodeficiency virus (PLWH) and a barrier to achieving viral suppression. Among PLWH who report illicit drug use, we evaluated associations between HIV viral load (VL) and reduced use of illicit opioids, methamphetamine/crystal, cocaine/crack, and marijuana, regardless of whether or not abstinence was achieved. Methods This was a longitudinal cohort study of PLWH from 7 HIV clinics or 4 clinical studies. We used joint longitudinal and survival models to examine the impact of decreasing drug use and of abstinence for each drug on viral suppression. We repeated analyses using linear mixed models to examine associations between change in frequency of drug use and VL. Results The number of PLWH who were using each drug at baseline ranged from n = 568 (illicit opioids) to n = 4272 (marijuana). Abstinence was associated with higher odds of viral suppression (odds ratio [OR], 1.4–2.2) and lower relative VL (ranging from 21% to 42% by drug) for all 4 drug categories. Reducing frequency of illicit opioid or methamphetamine/crystal use without abstinence was associated with VL suppression (OR, 2.2, 1.6, respectively). Reducing frequency of illicit opioid or methamphetamine/crystal use without abstinence was associated with lower relative VL (47%, 38%, respectively). Conclusions Abstinence was associated with viral suppression. In addition, reducing use of illicit opioids or methamphetamine/crystal, even without abstinence, was also associated with viral suppression. Our findings highlight the impact of reducing substance use, even when abstinence is not achieved, and the potential benefits of medications, behavioral interventions, and harm-reduction interventions.

Zinc Status in Human Immunodeficiency Virus Type 1 Infection and Illicit Drug Use

2003 ◽  
Vol 37 (s2) ◽  
pp. S117-S123 ◽  
Author(s):  
Marianna K. Baum ◽  
Adriana Campa ◽  
Shengan Lai ◽  
Hong Lai ◽  
J. Bryan Page
Keyword(s):  
Human Immunodeficiency Virus ◽  
Drug Use ◽  
Human Immunodeficiency Virus Type ◽  
Virus Type ◽  
Illicit Drug ◽  
Illicit Drug Use ◽  
Zinc Status ◽  
Immunodeficiency Virus

Reducing the Risk of Human Immunodeficiency Virus Infection Associated With Illicit Drug Use

PEDIATRICS ◽  
1994 ◽  
Vol 94 (6) ◽  
pp. 945-947
Author(s):  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Drug Use ◽  
Hiv Infection ◽  
Drug Users ◽  
Illicit Drug ◽  
Health Benefit ◽  
Illicit Drug Use ◽  
Injection Drug ◽  
Relative Safety ◽  
Immunodeficiency Virus

Injection and other illicit drug use plays a major role in the transmission of infection with human immunodeficiency virus (HIV), including cases among infants, children, and adolescents.1,2 Transmission to adolescents and adults occurs either directly from contaminated drug paraphernalia, including needles and syringes, or through sexual contact with an infected partner. Transmission to infants occurs transplacentally or perinatally from mothers who are most often either drug users themselves, or who have become infected from sexual partners who are injection drug users. It is therefore clear that a reduction in the transmission of HIV infection secondary to illicit drug use and the use of contaminated injection equipment is a pediatric concern and should be part of any prevention program. The adverse consequences of illicit drug use are multiple and certainly not limited to the potential acquisition and transmission of HIV infection. Ideally, treatment and prevention programs should seek to reduce drug use itself, not solely HIV infection. However, many users of injection drugs do not enter drug treatment, remain in treatment, or maintain complete abstinence while in treatment. Therefore, promoting safer injection practices can provide an important public health benefit in lowering the risk of HIV transmission, while simultaneous efforts continue to reduce and eliminate drug use. Initiatives with the singular objective of increasing access to sterile equipment are understandably controversial, as they do not directly address the causes and broader consequences of illicit drug use. In addition, there are continuing concerns that any program increasing access to sterile needles and syringes might actually increase injection drug use by creating the impression of relative safety and tacit community approval for such behavior.

scholarly journals Genital Shedding of Resistant Human Immunodeficiency Virus-1 Among Women Diagnosed With Treatment Failure by Clinical and Immunologic Monitoring

2016 ◽  
Vol 3 (1) ◽  
Author(s):  
Susan M. Graham ◽  
Vrasha Chohan ◽  
Keshet Ronen ◽  
Ruth W. Deya ◽  
Linnet N. Masese ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Treatment Failure ◽  
Genital Tract ◽  
Virologic Failure ◽  
Resistant Virus ◽  
Line Therapy ◽  
Immunodeficiency Virus ◽  
Genital Shedding ◽  
Dual Class ◽  
Hiv 1

Abstract Background.  The accumulation of human immunodeficiency virus (HIV) resistance mutations can compromise treatment outcomes and promote transmission of drug-resistant virus. We conducted a study to determine the duration and evolution of genotypic drug resistance in the female genital tract among HIV-1-infected women failing first-line therapy. Methods.  Treatment failure was diagnosed based on World Health Organization (WHO) clinical or immunologic criteria, and second-line therapy was initiated. Stored plasma and genital samples were tested to determine the presence and timing of virologic failure and emergence of drug resistance. The median duration of genital shedding of genotypically resistant virus prior to regimen switch was estimated. Results.  Nineteen of 184 women were diagnosed with treatment failure, of whom 12 (63.2%) had confirmed virologic failure at the switch date. All 12 women with virologic failure (viral load, 5855–1 086 500 copies/mL) had dual-class resistance in plasma. Seven of the 12 (58.3%) had genital HIV-1 RNA levels high enough to amplify (673–116 494 copies/swab), all with dual-class resistance. The median time from detection of resistance in stored samples to regimen switch was 895 days (95% confidence interval [CI], 130–1414 days) for plasma and 629 days (95% CI, 341–984 days) for genital tract secretions. Conclusions.  Among women diagnosed with treatment failure using WHO clinical or immunologic criteria, over half had virologic failure confirmed in stored samples. Resistant HIV-1 RNA was shed in the genital tract at detectable levels for ≈1.7 years before failure diagnosis, with steady accumulation of mutations. These findings add urgency to the ongoing scale-up of viral load testing in resource-limited settings.

scholarly journals The Impact of Direct-Acting Antivirals in the Hepatitis C-Sustained Viral Response in Human Immunodeficiency Virus-Infected Patients With Ongoing Barriers to Care

2015 ◽  
Vol 2 (4) ◽  
Author(s):  
Edward R. Cachay ◽  
David Wyles ◽  
Lucas Hill ◽  
Craig Ballard ◽  
Francesca Torriani ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hepatitis C ◽  
Barriers To Care ◽  
Sustained Viral Response ◽  
Treatment Protocol ◽  
Direct Acting Antivirals ◽  
Hcv Treatment ◽  
Viral Response ◽  
Immunodeficiency Virus ◽  
Direct Acting

Abstract Background.  Access to hepatitis C virus (HCV) medications for human immunodeficiency virus (HIV)-infected patients with ongoing barriers to care is restricted by healthcare payers in the absence of HCV treatment outcomes data in the era of direct-acting antivirals (DAA). Methods.  Retrospective analysis of HCV treatment outcomes using interferon (IFN)-free DAA regimens and an inclusive treatment protocol in an urban HIV clinic where ongoing barriers to care (drug or alcohol use, psychiatric disease, and/or unstable housing) are common. Then, using logistic regression analysis, we compared the proportion of HIV-infected patients who achieved HCV sustained viral response (SVR) in the pegylated-IFN plus ribavirin (PEG-IFN/RBV, 2008–2011), pegylated-IFN plus ribavirin and telaprevir (PEG-IFN/RBV/PI, 2011–2013), and IFN-free DAA therapy eras (2014). Results are displayed using forest plots. Results.  The proportion of patients who achieved HCV SVR in the PEG-IFN/RBV, PEG-IFN/RBV/PI, and IFN-free DAA therapy eras increased from 38.4% (95% confidence interval [CI], 23.2–53.7) and 48% (95% CI, 28.4–67.6) to 83.3% (95% CI, 70.0–96.7), respectively. Similar proportions of patients with ongoing barriers to care were treated during the PEG-IFN/RBV (25 of 39 [64%]), PEG-IFN/RBV/PI (14 of 25 [56%]), and IFN-free DAA (16 of 30 [53%]) eras. Hepatitis C virus SVR among patients with ongoing barriers to care improved from 40% (95% CI, 21–59) to 76.5% (95% CI, 56–97) in the PEG-IFN/RBV and IFN-free DAA eras, respectively. After stratification for factors associated with HCV SVR such as HCV genotype and cirrhosis, HCV SVR were similar in patients regardless of the presence of ongoing barriers to care. Conclusions.  Using IFN-free DAA and an inclusive HCV treatment protocol, 76.5% of HIV/HCV-treated patients with ongoing barriers to care achieved HCV SVR.

scholarly journals HAART receipt and viral suppression among HIV-infected patients with co-occurring mental illness and illicit drug use

AIDS Care ◽  
2009 ◽  
Vol 21 (5) ◽  
pp. 655-663 ◽  
Author(s):  
Geetanjali Chander ◽  
Seth Himelhoch ◽  
John A. Fleishman ◽  
James Hellinger ◽  
Paul Gaist ◽  
...  
Keyword(s):  
Mental Illness ◽  
Drug Use ◽  
Viral Suppression ◽  
Illicit Drug ◽  
Illicit Drug Use

From conduct disorder to severe mental illness: associations with aggressive behaviour, crime and victimization

2007 ◽  
Vol 38 (7) ◽  
pp. 975-987 ◽  
Author(s):  
S. Hodgins ◽  
A. Cree ◽  
J. Alderton ◽  
T. Mak
Keyword(s):  
Mental Illness ◽  
Drug Use ◽  
Conduct Disorder ◽  
Severe Mental Illness ◽  
Violent Crime ◽  
Aggressive Behaviour ◽  
Illicit Drug ◽  
Illicit Drug Use ◽  
Men And Women ◽  
Increased Risk

BackgroundConduct disorder (CD) prior to age 15 has been associated with an increased risk of aggressive behaviour and crime among men with schizophrenia. The present study aimed to replicate and extend this finding in a clinical sample of severely mentally ill men and women.MethodWe examined a cohort of in-patients with severe mental illness in one mental health trust. A total of 205 men and women participated, average age 38.5 years. CD was diagnosed using a structured diagnostic tool. Alcohol and illicit drug use, aggressive behaviour and victimization were self-reported. Information on convictions was extracted from official criminal records. Analyses controlled for age and sex.ResultsCD prior to age 15 was associated with an increased risk of assault over the lifespan [odds ratio (OR) 3.98, 95% confidence interval (CI) 1.87–8.44)], aggressive behaviour in the 6 months prior to interview (OR 2.66, 95% CI 1.24–5.68), and convictions for violent crimes (OR 3.19, 95% CI 1.46–6.97) after controlling for alcohol and illicit drug use. The number of CD symptoms present prior to age 15 significantly increased the risk of serious assaults over the lifespan, aggressive behaviour in the past 6 months, and violent crime after controlling for alcohol and illicit drug use.ConclusionsMen and women with severe mental illness who have a history of CD by mid-adolescence are at increased risk for aggressive behaviour and violent crime. These patients are easily identifiable and may benefit from learning-based treatments aimed at reducing antisocial behaviour. Longitudinal, prospective investigations are needed to understand why CD is more common among people with than without schizophrenia.

The level of illicit drug use is related to symptoms and premorbid functioning in severe mental illness

2008 ◽  
Vol 118 (4) ◽  
pp. 297-304 ◽  
Author(s):  
P. A. Ringen ◽  
I. Melle ◽  
A. B. Birkenaes ◽  
J. A. Engh ◽  
A. Faerden ◽  
...  
Keyword(s):  
Mental Illness ◽  
Drug Use ◽  
Severe Mental Illness ◽  
Illicit Drug ◽  
Illicit Drug Use ◽  
Premorbid Functioning
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