Hepatitis C infection and injection drug use: The role of hepatologists in evolving treatment efforts

Kresina, Thomas F.; Seeff, Leonard B.; Francis, Henry

doi:10.1002/hep.20367

Cited by 5 publications

(2 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The current reality for most patients falls far short of the treatment we have reviewed. There are many barriers to treatment of HCV infection in current or former injection drug users [87,[139][140][141][142][143][144][145]. Patients may have incomplete knowledge and understanding of HCV disease and may not know of available resources for HCV treatment [139,145].…”

Section: Methadone-related Issuesmentioning

confidence: 99%

“…They may be unaware of their personal status regarding HCV, HIV or other health issues [139,145]. Other medical or psychiatric conditions, use of illicit drugs or alcohol, lack of adequate housing or legal difficulties may reduce interest in, or adherence to antiviral therapy [87,[141][142][143]. Other patient-related barriers include distrust of the health-care system, difficulties with transportation to treatment sites, fear of adverse effects and penalties for missed visits [140,143,144].…”

Section: Methadone-related Issuesmentioning

confidence: 99%

See 1 more Smart Citation

Critical issues in the treatment of hepatitis C virus infection in methadone maintenance patients

Novick

Kreek

2008

Addiction

View full text Add to dashboard Cite

show abstract

Section: Methadone-related Issuesmentioning

confidence: 99%

Section: Methadone-related Issuesmentioning

confidence: 99%

Critical issues in the treatment of hepatitis C virus infection in methadone maintenance patients

Novick

Kreek

2008

Addiction

View full text Add to dashboard Cite

show abstract

Hepatitis C treatment, subcutaneous naltrexone implants, and methadone maintenance treatment

Novick

Kreek

2007

Hepatology

View full text Add to dashboard Cite

We acknowledge the interest shown by Drs. Kalaityakis and Bjornsson and by Paparrigopoulos and coworkers in our study. We did evaluate for the side effects of lactulose in our patients but none of them reported it. Patients in the treatment arm were explained the mechanism of action of lactulose and were told that for lactulose to be effective it was desirable to titrate their dose to get 2-3 semisoft stools daily. Therefore, it is unlikely that gastrointestinal symptoms (diarrhea) due to lactulose had any significant effect on health-related quality of life (HRQOL) in the patients included in our study.Several other factors could be responsible for gastrointestinal symptoms and impaired HRQOL in patients with cirrhositic liver. As studied by Kalaityakis et al, 1 Child-Pugh score and gastrointestinal comorbidities such as ulcerative colitis, Crohn's disease and untreated celiac disease could also affect the HRQOL negatively. None of these gastrointestinal co-morbidities were present in our study population. Moreover the majority of patients in our study had Child's A or B cirrhosis and only 13% were in Child's C class. Finally, we agree with Drs. Kalaityakis and Bjornsson that improved patient awareness about the actions of lactulose could potentially help in decreasing its side effects, as has been demonstrated in our study.In a second letter, Paparrigopoulos and coworkers showed their concern regarding ammonia as a cause for cognitive deficits in our patients with minimal hepatic encephalopathy (MHE), which could be related to chronic abuse of alcohol. Ammonia has been suggested to be a key factor in the pathogenesis of MHE. 2 Additional convincing evidence that ammonia may be responsible for the pathogenesis of this syndrome has come from a study by Minguez and coworkers. 3 This study shows that at least 50% of patients with portal vein thrombosis exhibit impairment of neuropsychological tests associated with high ammonia levels after the administration of glutamine, and abnormalities on magnetic resonance imaging and spectroscopy that are indicative of increased metabolism of ammonia in the brain. Further, cognitive/ neuropsychological deficits improve with treatment modalities that reduce ammonia level, for example, lactulose 4 and probiotics. 5 We did not measure ammonia levels in our patients; therefore, ammonia as pathogenetic mechanism in our patients remains at best speculative.Chronic alcohol abuse or associated comorbidities, such as mood and anxiety disorders, psychotic disorders and personality disorders may produce cognitive/neuropsychological deficits and may be reversible on abstinence. 6,7 Although we can not totally exclude the longlasting toxic effect of alcohol leading to neuropsychological deficits in our patients, however, it is unlikely for several reasons. First, a majority of our patients with alcoholic cirrhosis were abstaining from alcohol for a long time; recent literature suggests metabolic and morphological recovery following short-and long-term abstinence. 6,7 Second, the preva...

show abstract

Mapping the Barriers and Facilitators of HCV Treatment Initiation in Methadone Maintenance Therapy Patients: Implications for Intervention Development

Bass

Jessop²,

Maurer

et al. 2017

Journal of Health Communication

View full text Add to dashboard Cite

An estimated 70-90% of current methadone users have Hepatitis C (HCV). Current treatments have few side effects and can cure infection in 8-12 weeks, but less than 10% of methadone patients initiate treatment. Engaging this group in treatment is an important strategy to lower both morbidity and mortality from liver disease and eliminate a significant reservoir of HCV in communities. To understand how to address this treatment gap we used commercial marketing techniques called perceptual mapping and vector message modeling to analyze survey data from 100 HCV+ methadone patients from four centers in Philadelphia. Results were used to understand barriers and facilitators to treatment initiation and to devise targeted message strategies to adapt to a mobile health communication intervention. Results indicate that focusing on how treatment can make one feel "in charge", positive interactions with healthcare providers, the positive attributes of the new vs. old HCV treatments, and providing strategies to address tangible barriers to getting treatment, would be important to address in a communication intervention. These marketing methods allow for focusing on specific variables to "move" the group toward a treatment decision, making them an innovative technique to use in developing highly targeted health communication messages.

show abstract

Hepatitis C infection and injection drug use: The role of hepatologists in evolving treatment efforts

Cited by 5 publications

References 36 publications

Critical issues in the treatment of hepatitis C virus infection in methadone maintenance patients

Critical issues in the treatment of hepatitis C virus infection in methadone maintenance patients

Hepatitis C treatment, subcutaneous naltrexone implants, and methadone maintenance treatment

Mapping the Barriers and Facilitators of HCV Treatment Initiation in Methadone Maintenance Therapy Patients: Implications for Intervention Development

Contact Info

Product

Resources

About