Hepatitis C and HIV Infections: Implications for Clinical Care in Injection Drug Users

Abstract

Our objective is to provide a state-of-the-art review on hepatitis C (HCV) and the human immunodeficiency virus (HIV) in injection drug users (IDUs), highlighting important clinical issues. We performed a literature review from the MEDLINE database for research from 1966 to 2003, with an emphasis on recent consensus documents. Of the estimated 15 million illicit drug users in the U.S., approximately 1.0 to 1.5 million inject drugs. IDUs are at significant risk of contracting HCV and HIV, with IDUs accounting for 60% of new HCV cases and 25% of new HIV infections. It is a major risk factor for HCV/HIV coinfection, which significantly impacts on each disorder's progression. It appears that treatment response in IDUs with HCV or HIV is similar to non-IDUs with these viruses and that medication adherence and treatment outcomes are optimized when linked with substance abuse treatment. Providers caring for patients who are or were IDUs must be aware of the management of these diseases and make efforts to integrate their medical care with the treatment of their substance abuse.

Medical Consequences of Drug Abuse and Co-occurring Infections: A Brief Review

“…Major depression is a common comorbidity in patients with Hepatitis C infection [37] . Hepatitis C patients also have poorer outcomes if they are ongoing drug users [26] . Alcohol is risk factor for Hepatitis C infection, probably through the indirect mechanisms, but it is also associated with more rapid progression of HCV and more frequent development of liver cancer [38] .…”

“…About 75 to 85% of these patients may become chronically infected. During the chronic phase of HCV infection, which may last several decades, symptoms may include nausea, anorexia, myalgia, and arthralgia, with fatigue being the most common complaint [26] . Alcohol use and advanced age accelerate the disease progression of HCV infection, especially among men.…”

Neuroendocrine Abnormalities in Drug Abusers and HIV-Infected Individuals: Cortisol Response to Cold Pressor Challenge

“…There are multiple risk factors for contracting HIV infection and most of the earlier reports on endocrine effects have been conducted in individuals contracting infection via unsafe sex. One of the major risk factors for HIV infection is injecting drug use (IDU) [18,19] . Opiates, or heroin and specific forms of cocaine are the primary substances injected by IDUs although other forms of cocaine as well as marijuana are also used via other routes.…”

Barriers to Nutrition Counseling with a Registered Dietitian (RD) and Its Association with Dietary Intake, Nutrition Status, Disease Outcomes and Substance Abuse in People Living with HIV (PLWH).

“…98 Effective treatment for these chronic conditions can be very challenging in HIV-positive individuals who continue to use these substances. 98 Untreated illicit drug abuse has a negative impact on access to HIV-related treatment and care and HIV outcomes, such as disease progression.…”

“…96, 98,99 Currently, exploration of the relationship between substance abuse and dietary counseling in HIV-infected individuals is limited, but it is known that the risk of malnutrition in the HIV population is greater amongst substance abusers.…”