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Medical and Behavioral Approaches to Engage People Who Inject Drugs Into Care for Hepatitis C Virus Infection

Gonzalez, Stevan A. MD, MS*; Fierer, Daniel S. MD; Talal, Andrew H. MD, MPH

Addictive Disorders & Their Treatment: June 2017 - Volume 16 - Issue 2, Supplement 1 - p S1–S23
doi: 10.1097/ADT.0000000000000104
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Direct-acting antivirals for hepatitis C virus infection may revolutionize treatment among persons with substance use disorders. Despite persons with substance use disorders having the highest hepatitis C virus prevalence and incidence, the vast majority have not engaged into care for the infection. Previously, interferon-based treatments, with substantial side effects and the propensity to exacerbate mental health conditions, were major disincentives to pursuit of care for the infection. Direct-acting antivirals with viral eradication rates of >90%, significantly improved side effect profiles, and shorter treatment duration are dramatic improvements over prior treatment regimens that should promote widespread hepatitis C virus care among persons with substance use disorders. The major unmet need is strategies to promote persons with substance use disorders engagement into care for hepatitis C virus. Although physical integration of treatment for substance use and co-occurring conditions has been widely advocated, it has been difficult to achieve. Telemedicine offers an opportunity for virtual integration of behavioral and medical treatments that could be supplemented by conventional interventions such as hepatitis C virus education, case management, and peer navigation. Furthermore, harm reduction and strategies to reduce viral transmission are important to cease reinfection among persons with substance use disorders. Widespread prescription of therapy for hepatitis C virus infection to substance users will be required to achieve the ultimate goal of global virus elimination. Combinations of medical and behavioral interventions should be used to promote persons with substance use disorders engagement into and adherence with direct-acting antiviral-based treatment approaches. Ultimately, either physical or virtual colocation of hepatitis C virus and substance use treatment has the potential to improve adherence and consequently treatment efficacy.

*Division of Hepatology, Baylor Simmons Transplant Institute, Fort Worth, TX

Icahn School of Medicine at Mt. Sinai, New York

Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine, State University of New York at Buffalo, Buffalo, NY

Research reported in this article was partially funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (IHS-1507-31640), the Troup Fund of the Kaleida Health Foundation, the Chronic Liver Disease Foundation, and through unrestricted educational grants from Merck, AbbVie, and Gilead Sciences. The statements in this article are solely the responsibility of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors, or Methodology Committee.

S.A.G.: Speaker’s Bureau—AbbVie, Gilead, Merck; Advisory board—AbbVie. D.S.F.: reports owning stock in Gilead Sciences. A.H.T.: Grant/Research Support—Merck, Gilead, Abbott, AbbVie, Intercept, Tobira, Conatus; Committee/Advisor—Merck, Abbott Diagnostics, AbbVie, Chronic Liver Disease Foundation; Speaker’s Bureau—Chronic Liver Disease Foundation.

Reprints: Andrew H. Talal, MD, MPH, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine, State University of New York at Buffalo, 875 Ellicott Street, Suite 6089, Buffalo, NY 14203 (e-mail: ahtalal@buffalo.edu).

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