HIV/HCV Co-infection: Burden of Disease and Care Strategies in Appalachia

Abstract

The rise of the opioid crisis has fueled a rise in new hepatitis C infection, and a rise in new HIV infection is expected to follow. Injection drug use has directly contributed to the epidemic and continues to remain a risk factor. Men who have sex with men remains a significant risk factor for HIV acquisition as well. Progress has been made in the battle against HIV and, to a lesser extent, hepatitis C, but much more can be done. Limited data on co-infection with HIV/HCV are currently available for this at-risk region, but it is clear that Appalachia is highly vulnerable to co-infection outbreaks. A multipronged approach that includes advances in assessment of co-infection and education for both patients and clinicians can help to recognize, manage, and ideally prevent these illnesses.

Modelling T-cell immunity against hepatitis C virus with liver organoids in a microfluidic coculture system

“…About 20% of patients clear infections spontaneously, but the remainder establish a lifelong infection, which is often not diagnosed until severe liver disease has occurred [ 2 ]. While the incidence of HCV in the United States has remained lower than in some other regions, the opioid epidemic has led to an increase in HCV cases due to needle sharing [ 3 ]. Despite the recent introduction of direct-acting antivirals against HCV, the global disease burden remains high, related to lack of access to treatment, expense of drugs and the possibility of reinfection after successful treatment is completed [ 4 ].…”

Assessing the Relationships Between COVID-19 Stay-at-Home Orders and Opioid Overdoses in the State of Pennsylvania

“…While academic scholarship has provided important detail on the opioid epidemic, there remain critical gaps in existing knowledge of how COVID-19 is affecting patterns of opioid addiction and overdose. Previous research attention to the opioid epidemic has concentrated on several thematic areas, including the geographic locations and drivers of the crisis (Dasgupta et al, 2018;King et al, 2014;Mazumdar et al, 2015), economic impacts (Inocencio et al, 2013;Poitras, 2012), urban-rural patterns of prescription opioid misuse (Cerdá et al, 2017;Palombi et al, 2018;Rigg & Monnat, 2014), and human immunodeficiency virus (HIV) and hepatitis C (HCV) co-infection (Moorman et al, 2018;Schranz et al, 2018;Zibbell et al, 2018). These dynamics are anticipated to be even more pronounced due to the COVID-19 pandemic.…”

Community pharmacist engagement in HIV and HCV prevention: Current practices and potential for service uptake

“… 25 , 34 To reduce HIV/HCV-related morbidity and mortality in the Appalachian region, a comprehensive approach of accessible prevention, detection, and treatment strategies is needed. 11 , 25 , 36 One potential strategy for increasing the reach of HIV/HCV prevention efforts in rural areas is through provision of services at community pharmacies. 37 , 38 , 39 With more than 60,000 community pharmacies in the US 40 and approximately 90% of Americans living within 5 miles of a pharmacy, 41 pharmacists may be considered the most accessible health care providers, particularly in rural communities with limited health care resources.…”