When Epidemics Overlap: Opioids, HIV, HCV
Nonmedical use of oral prescription opioids overlaps with and fuels widespread HIV and HCV infections and serves as a gateway to other injection drugs.
A new metanalysis,2 however, suggests high rates of cure among people with HCV who inject drugs. Treating these high risk individuals could potentially interrupt HCV transmission. Results underscore the importance of not excluding them from treatment. The 2 new studies are reviewed above.
Opioid, HCV, HIV Epidemics in NYC. Study: Assess relationships among non-medical use of Rx opioids, heroin use, & HIV & HCV infection in persons who inject drugs in NYC, 2016–2018.
Nonmedical Opioid Use is an Overlapping Epidemic. In past 6 months, among injection drug users:
- 95% injected heroin
- 44% injected cocaine
- 56% used oral prescription opioids
- 6% injected opioids
- All individuals who used prescription opioids also injected heroin
Conclusions: Nonmedical use of oral and injection prescription opioids is integral to HIV/HCV polydrug epidemic in NYC.
Meta-analysis of DAA Outcomes in IV Drug Users. Study: Evaluated studies of SVR at least 12 wks post-treatment among IV drug users & those on opioid substitution therapy.
HCV Cure Rates High, Reinfection Low. High pooled SVR: Recent IV drug users: 88%; opioid substitution therapy: 91%.
Pooled treatment discontinuation for IV drug users and opioid substitution therapy: 2%.
Conclusions: Do Not Exclude Injection Drug Users
- No support for exclusion of IV drug users from HCV treatment
- Limitation: short-term studies so long-term reinfection risk unclear
- Prevent reinfection: education, harm reduction services
- Post-treatment surveillance needed for reinfection & retreatment
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References
1. Des Jarlais DC, Arasteh K, McKnight C, et al. Prescription opioid analgesics, heroin, HIV and HCV among persons who inject drugs in New York City, 2016-2018. Drug Alcohol Depend. 2019 Aug 30;204:107459. doi: 10.1016/j.drugalcdep.2019.04.030.
2. Latham NH, Doyle JS, Palmer AY, et al. Staying hepatitis C negative: A systematic review and meta-analysis of cure and reinfection in people who inject drugs. Liver Int. 2019 May 24. doi: 10.1111/liv.14152.D
Nonmedical use of oral prescription opioids in New York City is an epidemic in itself, according to a new study,1 and significantly overlaps with already widespread infection with hepatitis C and HIV. Use of oral opioids may be also be a gateway to use of heroin and other injection drugs--a behavioral sequence that may contribute to further infection transmission. In 2018, NYC started the “eliminate HCV” campaign. But HCV treatment programs may still exclude people who inject drugs, due to concerns over reduced efficacy of direct acting antivirals (DAAs) and risk for reinfection.
