HIV, Hepatitis C outbreak continues in Indiana

BATESVILLE, IN (FOX19) - It's been months since the story about southeastern Indiana’s HIV epidemic went national and now, the state is still trying to bounce back from what Governor Pence called 'the worst outbreak in state history.' The outbreak is stemming from the widespread heroin problem in the region.

On Thursday, FOX19 NOW spoke with a doctor in Batesville, Indiana who told us if users don't get tested for HIV soon, the problem is only going to get worse.

The heroin crisis in Indiana has caused an explosion of not only HIV cases but Hepatitis C cases in the area as well.

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Hepatitis C May Increase Risk of Heart Disease

Positive hepatitis C infection may increase risk for liver damage as well as future heart problems, according to findings published in The Journal of Infectious Diseases.  

Researchers from Johns Hopkins Medicine evaluated almost 1,000 men aged 40 to 70 years with or without human immunodeficiency virus (HIV), of which 87 also had hepatitis C in order to measure associations between hepatitis C with coronary atherosclerosis. About 750 men participating in the study also underwent CT angiography. The participants, who did not have overt existing heart disease, were recruited from the Multicenter AIDS Cohort Study, a larger study focused on men who have sex with men.

Prior research demonstrated that people with HIV already have an elevated risk for heart disease, but the researchers believe their findings here offer strong support for hepatitis C also contributing to cardiovascular damage independent of HIV status.

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RIVERSIDE COUNTY: Woman on a mission to get clean needles to drug users

Motivated by friends' deaths, she is setting up a nonprofit group and lobbying local officials -- with some offering resistance and some expressing support.

Growing up, Katie Chamberlain walked the straight and narrow as a “dorky straight-A student.”

The Riverside resident attended a Christian school until ninth grade. The stark reality of drugs hit home the second week of classes, when a classmate died of a heroin overdose.

Over the years, the 27-year-old watched with sadness and despair as too many friends fell victim to illegal narcotics.

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NYU Researchers Find Development of Serious Liver Damage in Mid- to Late-adulthood Among People Who Inject Drugs with Untreated Chronic Hepatitis C Infection

October 5, 2015
N-56 2015-16

Few people who inject drugs are engaged in needed care for chronic HCV infection; Early engagement in treatment needs to be a policy priority for these individuals

The Hepatitis C virus (HCV) infection is a chronic blood-borne viral infection that affects an estimated 160 million people, or 2-3% of the population world-wide. Alarmingly, chronic HCV infection accounts for one-quarter of the cases of cirrhosis and hepatocellular carcinoma (HCC). If HCV is left untreated, chronic liver disease will occur in 60–70% of the cases, cirrhosis in 5–20% of the cases, and 1–5% will die from decompensated cirrhosis or HCC.

In most high-income countries, such as the United States, where drug injection is the primary route of HCV transmission, the disease is concentrated among people who inject drugs (PWID). While it is estimated that 50–80% of PWID are chronically infected, fewer than 5% of PWID have received treatment.

In a new study, “Hepatitis C virus (HCV) disease progression in people who inject drugs (PWID): A systematic review and meta-analysis,” published in the International Journal of Drug Policy, a team of researchers from New York University’s Center for Drug Use and HIV Research (CDUHR) assessed existing data on the natural history of HCV among PWID. A total of twenty-one studies examined over 8500 PWID, who contributed nearly 120,000 person-years at risk, for the study of four major HCV-related outcomes included in the synthesis.

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Why needle exchange programs work

 By Kara Blake

As a vocal advocate for harm reduction and needle exchange services, I have often been asked, “why needle exchange?” To public health professionals, needle exchange programs (NEPs) are an obvious and urgently needed intervention. Research study after research study continues to show conclusively that NEPs reduce the transmission of HIV and viral hepatitis, are tremendously cost-effective, and provide a range of other services that benefit the participants and greater community. Even though the evidence is clear, public and political pushback against NEPs persists across the country. Cape Cod is no exception.

Without proper information, it might make sense that a citizen or politician may be resistant to the idea of a needle exchange. How could this intervention possibly support drug users? Won’t this only perpetuate their addiction and its consequences? Won’t this facility increase crime and drug use in my community? The answer, plainly, across the board, is no.

Someone who accesses a needle exchange is making what can be the first contact with a professional about their addiction. Recognizing that not all people using drugs are ready, willing or able to stop using at that moment, staff compassionately discuss and educate participants on the potential harms associated with their drug use, and how to reduce those harms. Rather than shame drug users and require abstinence, staff meet and talk with people where they are in their addiction without judgment. This approach is called “harm reduction.” Through such relationships, participants are also able to access services such as screening for HIV, hepatitis C and sexually transmitted infections, access to Narcan and overdose prevention, enrollment in health insurance, and referrals to substance use treatment and medical care.

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Women Living with HIV Face Higher Rates of Cancer Diagnosis: Study

Vancouver, BC [September 15, 2015] Due to the introduction of modern highly active antiretroviral therapy (HAART), people living with HIV are now much less likely to develop AIDS-related cancers, which were characteristic of the epidemic in the 1980s. However, a new study published in HIV Medicine shows women living with HIV still have a higher likelihood of being diagnosed with certain cancers, when compared with the general population.

While rates of AIDS-defining malignancies may be decreasing over time, there has been an observed increase in non-AIDS defining malignancies among women living with HIV compared to the general population. This trend primarily involves cancers with underlying infectious causes such as human papillomavirus (HPV) and hepatitis.

“This research suggests chronic inflammation, immune-suppression, aging and viral infections may be contributing to the cancer risk,” said Dr. Robert Hogg, Senior Research Scientist at the BC Centre for Excellence in HIV/AIDS (BC-CfE) and Professor at Simon Fraser University. Dr. Hogg is the thesis supervisor for Kate Salters, the study’s main author. “The study highlights the importance of ongoing access to HIV care and cancer screening practices that are specific to the risks facing women living with HIV. With sustained treatment, women with HIV are now able to live longer, healthier lives – making it increasingly important to address emerging health needs.”

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Huntington needle exchange program set to launch

HUNTINGTON, W.Va. — West Virginia’s first-of-its-kind syringe exchange program will launch Wednesday in Huntington and Cabell County.

“The community has recognized a need and demand of this service for some time and we’re just excited to be able to offer it,” said Michael Kilkenny, the physician director for the Cabell-Huntington Health Department.

The pilot project will involve education and treatment resources to make clean needles more readily available. There will also be efforts to stop the spread of infectious diseases, like hepatitis B and hepatitis C, by giving addicts points of contact within the health department.

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Children as young as 10 are getting tattoos illegally, without realising they risk catching HIV and hepatitis

Children as young as 10 are getting tattoos, shocking new figures have revealed.

A worrying number of youngsters are visiting illegal tattoo parlours, unaware it is against the law for them to be inked before they are 18.

And half admitted to being unaware of the risk of infection from HIV and hepatitis.

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The end of hepatitis C?

2014 will do down as a pivotal year in the fight against hepatitis C virus (HCV), a blood-borne infection that is thought to infect around 2.5% of the world's population - some 170 million people.

The availability of new, more effective therapies for hepatitis C virus have raised the tantalising prospect of being able to eliminate the infection on a global basis,  although there are still significant obstacles to overcome.

Viral hepatitis - which generally means hepatitis B and C - “kills more people every year than HIV, malaria and tuberculosis combined, but has not had the same level of resources committed to it,” according to Charles Gore, who is chief executive of the Hepatitis C Trust in the UK and president of the World Hepatitis Alliance (WHA).

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Sustained virological response represents a long-term cure for people with hepatitis C treated with sofosbuvir

Almost all patients with hepatitis C virus (HCV) alone or HIV and HCV co-infection who achieved sustained virological response (SVR) to treatment with sofosbuvir (Sovaldi) plus ribavirin or sofosbuvir/ledipasvir (Harvoni) still had undetectable HCV RNA up to two years later, confirming that SVR represents a cure, according to a poster presented at the recent Conference on Retroviruses and Opportunistic Infections (CROI 2015) in Seattle, USA.

The advent of interferon-free therapy using combinations of direct-acting antiviral drugs has brought about a revolution in hepatitis C treatment. Sustained virological response, or continued undetectable HCV RNA at 12 or 24 weeks post-treatment, is considered a cure, but rare cases of apparent late relapse have been observed after this point. (More often, HCV recurrence is due to reinfection.) 

While some studies have detected residual bits of HCV in the blood or the liver after successful treatment, this does not appear to indicate ongoing active disease. Interferon-based therapy has been shown to have a late relapse rate below 5% – usually occurring within two years after treatment – but this is not yet well defined for interferon-free therapy because it is so new.

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Re-infection due to ongoing risk probably the cause of HCV recurrence after SVR

Rates of hepatitis C virus (HCV) reoccurrence after successful therapy differ markedly between risk groups, according to the results of a meta-analysis presented at the recent Conference on Retroviruses and Opportunistic Infections. 

At one end of the spectrum, over a fifth of patients with HIV co-infection who cleared HCV infection with treatment experienced a recurrence of the infection. This compared to a rate just 1% in patients with no HCV risk factors. The UK investigators leading the study believe these large differences point to re-infection rather than relapse being the cause of the re-emergence of HCV after treatment response.

HCV infection is an increasingly important cause of liver-related illness and death around the world. Diagnosing and treating HCV is therefore a global health priority, especially as therapy with combinations of new direct-acting anti-HCV drugs can achieve a cure or sustained virological response (SVR) – absence of HCV RNA 24 weeks after the completion of therapy – in up to 90% of patients.    

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Seattle-HIV testing in ED serves as link to care

"SEATTLE — An HIV testing program in an ED, which was originally implemented to describe the local epidemic, played a significant role in linking individuals to care, according to data presented at CROI 2015".

“Over a 25-year period, the program evolved, and this change is partially evidenced by declining undiagnosed HIV infection, increased use of antiretroviral therapy, increased viral suppression and decline in HIV incidence,” Thomas C. Quinn, MD, of the National Institute of Allergy and Infectious Diseases, said during his presentation".

"Quinn and colleagues examined local trends in HIV and hepatitis C in the Johns Hopkins Hospital ED population for a 25-year period. They conducted 6- to 8-week identity-unlinked serosurveys in the ED in 1987, 1988, 1992, 2001, 2007 and 2013. The study included 18,144 eligible patients who required a blood draw for a medical reason. Excess sera were collected, and specimens underwent ELISA testing followed by Western blot (from 1992-2013). The specimens also were tested for HCV in 1988 and from 2001 to 2013".

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Montreal-Hepatitis C cure rate of 97 per cent announced in study of patients co-infected with HIV given 12-week combination

MONTREAL, March 3, 2015 /CNW/ - A combination of two once-daily medications for chronic hepatitis C infection has been shown in newly released study results to cure almost all the patients who participated, despite the patients also being co-infected with human immunodeficiency virus (HIV). This patient population historically has been challenging to treat for hepatitis C, in large part due to potential drug-drug interactions between the antiviral therapy regimens used to treat each infection.

Results of ALLY-2, a Phase 3 clinical trial evaluating the investigational once-daily combination of daclatasvir and sofosbuvir for the treatment of chronic hepatitis C in patients co-infected with HIV were announced last week and showed that those treated for 12 weeks (HCV treatment-naïve and -experienced), 97% (n=149/153) achieved cure (sustained virologic response 12 weeks after treatment, or SVR12). 

"The data showed results that are very promising in patients that are well known as being both difficult to treat and at higher risk for developing serious liver disease, making the results all the more significant," said Dr. Stephen Shafran, Professor of Medicine (Infectious Diseases) at the University of Alberta. "It's also important to note that we are seeing high cure rates with the daclatasvir and sofosbuvir combination regardless of the genotype of the hepatitis C infection."

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