Issues in the Care and Treatment of HCV/HIV Co-Infection for Key Populations in Resource-Constrained Settings

Globally, the epidemic of hepatitis virus infection is increasing in the context of common viral transmission routes with the Human Immunodeficiency Virus (HIV). Thus, co-infection with both hepatitis virus and HIV is becoming a common occurrence, particularly for key populations. Studies of key populations, people who inject drugs, sex workers, transgendered individuals and men having sex with men, report high levels of illicit drug and/or alcohol use along with limited access to health care and medical treatment. Without the medical management of co-occurring substance use disorders and hepatitis C virus (HCV) infection, a significant proportion of this population with HCV/HIV co-infection will progress to chronic liver disease then subsequently end-stage liver disease. Thus, access to comprehensive care and treatment, including HCV testing with subsequent care and treatment of acute/chronic HCV infection is essential to address the global burden of disease. Increased efforts are needed globally to address the barriers to comprehensive care and treatment for key populations with HCV/HIV co-infection.

A model for retention and continuity of care and treatment for opioid dependent injection drug users in the Russian Federation

Health and Development Foundation has worked collaboratively with the Government of the Russian Federation to develop and implement a model program of retention and continuity of care for opioid dependence and HIV infection. The model utilizes the Narcology Detoxification Service, State AIDS Centers, Non Government Organization (NGO) managed narcology treatment and rehabilitation centers, NGO outreach programs and the community. The model program was developed and implemented as a pilot demonstration project to provide essential health services to injection drug users and retain them in care. The interventions developed and implemented comprised HIV Testing and Counseling, HIV/AIDS Narcology Post-Graduate Curriculum, Peer Support Groups (Buffer groups), Narcological Follow-up Phone Monitoring, Women’s Narcological Services and Short Messaging Services for Injection Drug Users. These services and interventions promoted the integration and utilization of HIV/AIDS health services and narcological services to form an evidence-based health service delivery model providing essential services to people who inject drugs and people living with HIV/AIDS in the Russian Federation.

Alcohol use disorder and its impact on chronic hepatitis C virus and human immunodeficiency virus infections

Alcohol use disorder(AUD) and hepatitis C virus(HCV) infection frequently co-occur. AUD is associated with greater exposure to HCV infection, increased HCV infection persistence, and more extensive liver damage due to interactions between AUD and HCV on immune responses, cytotoxicity, and oxidative stress. Although AUD and HCV infection are associated with increased morbidity and mortality, HCV antiviral therapy is less commonly prescribed in individuals with both conditions. AUD is also common in human immunodeficiency virus(HIV) infection, which negatively impacts proper HIV care and adherence to antiretroviral therapy, and liver disease. In addition, AUD and HCV infection are also frequent within a proportion of patients with HIV infection, which negatively impacts liver disease. This review summarizes the current knowledge regarding pathological interactions of AUD with hepatitis C infection, HIV infection, and HCV/HIV co-infection, as well as relating to AUD treatment interventions in these individuals.