The population of patients coinfected with HIV and hepatitis C in the U.S. remains largely marginalized for one reason or another. They are opioid drug users, Medicaid recipients, men who have sex with men; often, they are all the above. The fact that there are medications in the marketplace that can control or cure their dual infections makes their predicament even more frustrating. These are people who, clinically speaking, should be leading normal, healthy lives. Yet they are not.
Lianping Ti, PhD, a research scientist with the Epidemiology and Population Health program at the BC Centre for Excellence in HIV/AIDS and assistant professor in the Department of Medicine at the University of British Columbia, has focused largely on addiction. “You can’t understate that the over-prescription of opioids for pain has been a huge issue,” she said. “Trying to address the comorbid conditions of HIV, HCV and illicit drug use presents a host of challenges.”
Among the most important challenges is reinfection, according to Vincent Lo Re III, MD, MSCE, associate professor of medicine and epidemiology at the University of Pennsylvania. “The CDC and national and international societies need accurate and specific information to take the next steps toward hepatitis C elimination,” he said. “It is very important that we address hepatitis C treatment in high-risk subgroups to reduce the burden of liver disease, decrease hepatitis C transmission, and minimize hepatitis C reinfection after cure. These activities are crucial if we are to eliminate hepatitis C as a public health problem.”
With so many competing priorities, even successfully treating one of these patients can feel like an insurmountable task. Harm reduction programs need to be scaled up across the board, according to Ti. Surveillance and epidemiology of HIV/HCV coinfected populations and their associated comorbid conditions is essential, according to Lo Re. Access to HCV therapies remains problematic. Underlying all of this is a politically charged environment in which these patients rank lower than those with less stigmatized diseases.
Clinicians like Lo Re, who deal with these patients each day, see the reality of the impact of all this. “My patients are fearful and angry that they are being denied hepatitis C treatment,” he said.
But he continues to work, like so many others in the field — focused on specific obstacles and fighting the battle one patient and one issue at a time.
Safe Injection Habits
Horyniak and colleagues noted that incidence of coinfection among PWID are significantly lower in San Diego, Calif., than they are in Tijuana, Mexico, which lies just across the border. Baseline interviews and serologic testing data provided the study group with a wide range of information about the 567 study participants, including demographics, drug use habits, disease seropositivity and connections to and perceptions about Mexico.