Gonzalez Stevan A, Fierer Daniel S, Talal Andrew H
Division of Hepatology, Baylor Simmons Transplant Institute, Fort Worth, TX.
Icahn School of Medicine at Mt. Sinai, New York.
Addict Disord Their Treat. 2017 Jun;16(2 Suppl 1):S1-S23. doi: 10.1097/ADT.0000000000000104. Epub 2017 May 17.
Direct-acting antivirals for hepatitis C virus infection may revolutionize treatment among persons with substance use disorders. Despite persons with substance use disorders having the highest hepatitis C virus prevalence and incidence, the vast majority have not engaged into care for the infection. Previously, interferon-based treatments, with substantial side effects and the propensity to exacerbate mental health conditions, were major disincentives to pursuit of care for the infection. Direct-acting antivirals with viral eradication rates of >90%, significantly improved side effect profiles, and shorter treatment duration are dramatic improvements over prior treatment regimens that should promote widespread hepatitis C virus care among persons with substance use disorders. The major unmet need is strategies to promote persons with substance use disorders engagement into care for hepatitis C virus. Although physical integration of treatment for substance use and co-occurring conditions has been widely advocated, it has been difficult to achieve. Telemedicine offers an opportunity for virtual integration of behavioral and medical treatments that could be supplemented by conventional interventions such as hepatitis C virus education, case management, and peer navigation. Furthermore, harm reduction and strategies to reduce viral transmission are important to cease reinfection among persons with substance use disorders. Widespread prescription of therapy for hepatitis C virus infection to substance users will be required to achieve the ultimate goal of global virus elimination. Combinations of medical and behavioral interventions should be used to promote persons with substance use disorders engagement into and adherence with direct-acting antiviral-based treatment approaches. Ultimately, either physical or virtual colocation of hepatitis C virus and substance use treatment has the potential to improve adherence and consequently treatment efficacy.
用于丙型肝炎病毒感染的直接抗病毒药物可能会彻底改变物质使用障碍患者的治疗方式。尽管物质使用障碍患者的丙型肝炎病毒患病率和发病率最高，但绝大多数患者并未接受该感染的治疗。以前，基于干扰素的治疗有严重的副作用，且有加剧心理健康状况的倾向，这是促使患者寻求该感染治疗的主要阻碍。直接抗病毒药物的病毒根除率>90%，副作用明显改善，治疗持续时间缩短，与以前的治疗方案相比有显著改进，应该会促进物质使用障碍患者广泛接受丙型肝炎病毒治疗。主要未满足的需求是促进物质使用障碍患者接受丙型肝炎病毒治疗的策略。尽管广泛提倡将物质使用治疗与并发疾病的治疗进行实体整合，但很难实现。远程医疗为行为和医学治疗的虚拟整合提供了机会，可通过丙型肝炎病毒教育、病例管理和同伴导航等传统干预措施加以补充。此外，减少伤害和减少病毒传播的策略对于防止物质使用障碍患者再次感染很重要。要实现全球消除病毒的最终目标，需要向物质使用者广泛开具丙型肝炎病毒感染治疗药物的处方。应采用医学和行为干预措施相结合的方式，促进物质使用障碍患者参与并坚持基于直接抗病毒药物的治疗方法。最终，丙型肝炎病毒治疗和物质使用治疗的实体或虚拟并置有可能提高依从性，从而提高治疗效果。
