Recent Advances in Management of the HIV/HCV Coinfected Patient

Bednasz, Cindy J; Sawyer, Joshua; Martinez, Anthony; Rose, Patrick; Sithole, Samantha S; Hamilton, Holly R; Kaufman, Farzia S; Venuto, Charles S.; Ma, Qing; Talal, Andrew H.; Morse, Gene D.

doi:10.2217/fvl.15.64

Cited by 4 publications

(5 citation statements)

References 58 publications

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“…77 New direct-acting antiviral treatments are costly, but have low toxicity, short treatment durations, and can cure hepatitis C virus in more than 90% of patients, irrespective of HIV status. 78 An internationally funded hepatitis C elimination strategy in Georgia has allowed prisoners to access this treatment, but it is not accessible elsewhere in EECA prisons due to cost constraints. 79 …”

Section: The Confluence Of Mass Incarceration Substance Use Disordermentioning

confidence: 99%

The perfect storm: incarceration and the high-risk environment perpetuating transmission of HIV, hepatitis C virus, and tuberculosis in Eastern Europe and Central Asia

et al. 2016

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Despite global reductions in HIV incidence and mortality, the 15 UNAIDS-designated countries of Eastern Europe and Central Asia (EECA) that gained independence from the Soviet Union in 1991 constitute the only region where both continue to rise. HIV transmission in EECA is fuelled primarily by injection of opioids, with harsh criminalisation of drug use that has resulted in extraordinarily high levels of incarceration. Consequently, people who inject drugs, including those with HIV, hepatitis C virus, and tuberculosis, are concentrated within prisons. Evidence-based primary and secondary prevention of HIV using opioid agonist therapies such as methadone and buprenorphine is available in prisons in only a handful of EECA countries (methadone or buprenorphine in five countries and needle and syringe programmes in three countries), with none of them meeting recommended coverage levels. Similarly, antiretroviral therapy coverage, especially among people who inject drugs, is markedly under-scaled. Russia completely bans opioid agonist therapies and does not support needle and syringe programmes—with neither available in prisons—despite the country’s high incarceration rate and having the largest burden of people with HIV who inject drugs in the region. Mathematical modelling for Ukraine suggests that high levels of incarceration in EECA countries facilitate HIV transmission among people who inject drugs, with 28–55% of all new HIV infections over the next 15 years predicted to be attributable to heightened HIV transmission risk among currently or previously incarcerated people who inject drugs. Scaling up of opioid agonist therapies within prisons and maintaining treatment after release would yield the greatest HIV transmission reduction in people who inject drugs. Additional analyses also suggest that at least 6% of all incident tuberculosis cases, and 75% of incident tuberculosis cases in people who inject drugs are due to incarceration. Interventions that reduce incarceration itself and effectively intervene with prisoners to screen, diagnose, and treat addiction and HIV, hepatitis C virus, and tuberculosis are urgently needed to stem the multiple overlapping epidemics concentrated in prisons.

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Section: The Confluence Of Mass Incarceration Substance Use Disordermentioning

confidence: 99%

The perfect storm: incarceration and the high-risk environment perpetuating transmission of HIV, hepatitis C virus, and tuberculosis in Eastern Europe and Central Asia

et al. 2016

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“…However, recent findings have suggested that HCV may not be a sole contributor to the increased prevalence of COPD [21]. So, the effect of HCV infection could be magnified in HIV/HCV coinfected patients [22]. …”

Section: Introductionmentioning

confidence: 99%

Trends in Epidemiology of COPD in HIV-Infected Patients in Spain (1997–2012)

et al. 2016

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PurposeThe aim of this study was to estimate trends of incidence of hospital admissions and in-hospital mortality (IHM) in HIV-infected patients with COPD in the combination antiretroviral therapy (cART) era in Spain (1997–2012).MethodsA retrospective study with data from nationwide population-based COPD diagnoses in the Spanish Minimum Basic Data Set (MBDS) was performed. We established groups according to their HIV and HCV infections: 1) HIV-uninfected patients; 2) HIV-infected patients (with or without HCV coinfection).Results1,580,207 patients discharge with a COPD diagnosis were included in the study, 8902 of them were HIV-infected patients (5000 HIV-monoinfected patients and 3902 HIV/HCV-coinfected patients). The HIV-infected patients had higher incidence rates of hospital admissions for COPD than the HIV-uninfected patients during the study period. The HIV-monoinfected patients had higher rates of hospitalizations for COPD than the HIV/HCV-coinfected patients in the early-period cART (1997–1999), but these rates decreased in the first group and increased in the second, being even similar in both groups in the late-period cART (2004–2011). On the other hand, the HIV-infected patients with COPD had higher IHM than the HIV-uninfected patients with COPD. The mortality rates were higher in the HIV-monoinfected patients with COPD than in the HIV/HCV-coinfected patients with COPD in the early-period cART; however, in the late-period cART, the mortality rates trends seems higher in the HIV/HCV group. The likelihood of death in HIV/HCV-coinfected patients with COPD was similar to than in HIV-monoinfected patients with COPD.ConclusionsIncidence of hospital admissions for COPD and IHM have decreased among HIV-monoinfected individuals but have increased steadily among HIV/HCV-coinfected individuals in the cART era.

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“…Currently, with the advancement in HCV therapies and increased rate of HIV/HCV coinfection being simultaneously treated, new drug–drug interactions have become a concern . The effects may manifest in changes in systemic or tissue exposure of the DAA or ARV.…”

Section: Drug Interactions In Haart Era and Todaymentioning

confidence: 99%

“…The interaction pathways of some current DAAs can be rather complex, with agents being substrates, inhibitors, or inducers of multiple metabolic and transporter pathways . In addition, DAAs with different mechanisms of action are given in combination to increase efficacy and decrease the chance of resistant virus emerging.…”

Section: Clinical Pharmacology Of New Hcv Daasmentioning

confidence: 99%

“…The interaction pathways of some current DAAs can be rather complex, with agents being substrates, inhibitors, or inducers of multiple metabolic and transporter pathways. 13 In addition, DAAs with different mechanisms of action are given in combination to increase efficacy and decrease the chance of resistant virus emerging. Importantly, these combinations of DAAs have allowed for the removal of interferon from HCV regimens, 18 thus limiting the toxicity and burden of injections associated with this agent.…”

Section: Clinical Pharmacology Of New Hcv Daasmentioning

confidence: 99%

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Pharmacokinetic Considerations for Combining Antiretroviral Therapy, Direct‐Acting Antiviral Agents for Hepatitis C Virus, and Addiction Treatment Medications

Bednasz

Venuto

et al. 2017

Clinical Pharm in Drug Dev

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There are many factors that can affect the pharmacokinetics (PK) of drugs. Pathophysiological changes from disease states can alter the mechanisms that control the PK of antiretrovirals (ARVs), direct-acting antivirals (DAAs) and addiction treatment medications. Drug-drug interaction pathways of certain ARVs and DAAs can be very complex, with agents being substrates, inhibitors or inducers of multiple metabolic and transporter pathways. Buprenorphine and methadone may be used in HIV and hepatitis C virus (HCV) - infected patients, and may also be affected by drug interactions. Current research is focused on novel PK analyses, which aim to describe the PK of agents within the organs that host the infection of interest, such as within hepatocytes during treatment for HCV. Modeling techniques allow for the prediction of drug PK in specific organs and the plasma compartment. This review will provide a summary of these areas while exploring PK considerations for ARVs, DAAs, and addiction treatment medications.

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Recent Advances in Management of the HIV/HCV Coinfected Patient

Cited by 4 publications

References 58 publications

The perfect storm: incarceration and the high-risk environment perpetuating transmission of HIV, hepatitis C virus, and tuberculosis in Eastern Europe and Central Asia

The perfect storm: incarceration and the high-risk environment perpetuating transmission of HIV, hepatitis C virus, and tuberculosis in Eastern Europe and Central Asia

Trends in Epidemiology of COPD in HIV-Infected Patients in Spain (1997–2012)

Pharmacokinetic Considerations for Combining Antiretroviral Therapy, Direct‐Acting Antiviral Agents for Hepatitis C Virus, and Addiction Treatment Medications

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