Managing Patients with Addiction, HIV, HCV a Complex Challenge

Almost 90 percent of patients with HIV also have a hepatitis C infection (HCV), and many of these patients need to be treated for addiction, too. FDA approval of two new drugs, though, has increased the options for the complex management of these patients.

The treatment of these patients is a multidisciplinary challenge that will be explored Saturday in “Clinical Management of Substance Abusers with Co-occurring HIV and HCV Infections.” The session will be presented from 11 am to 12:30 pm in Governor’s Ballroom D, Fourth Floor.

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Jag H. Khalsa, MS, PhD

“These two new drugs are highly effective in treating hepatitis C infection to such an extent that within 12 weeks of therapy the patient is completely cleared of the virus,” said Jag H. Khalsa, MS, PhD, session organizer. “For physicians, the problem becomes ‘What should I treat first?’ Shall I treat a patient with HIV medications first, or treat the patient with HCV medications first?

“Then, should we treat these drug-abusing patients for drug dependence because they are really not very compliant with treatment protocols? So, the clinical management of this situation of drug abuse, HIV infection, and hepatitis C infection is a very complex and difficult task.”

The new drugs used to treat patients with HCV are directly acting antivirals (DAAs), sofosbuvir and ledipasvir, which can be used separately or in combination. Several other DAAs are in development but have not been approved by the Food and Drug Administration. Previously, patients with HCV were usually treated with ribavirin or gamma interferon, also called pegylated interferon.

Patients with HIV are treated using highly active antiretroviral therapy (HAART), which uses any of the 27 antiretroviral medications or combinations of two or more drugs. Patients with addiction generally are treated with methadone or buprenorphine for addiction involving opiates, and naltrexone for alcohol addiction, said Dr. Khalsa, Chief of the Medical Consequences Branch with the Division of Pharmacotherapies and Medical Consequences of Drug Abuse, National Institute on Drug Abuse, National Institutes of Health.

Joining Dr. Khalsa to sort through these many options will be two infectious disease experts. Jeffrey H. Samet, MD, MA, MPH, Chief and Professor of Medicine, Boston University School of Medicine, will discuss pain assessment in patients with HCV. David L. Thomas, MD, MPH, Professor and Chief of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, an expert in HCV and HIV, will discuss DAA therapy.

“For the person who comes to you for addiction-related infections, this session will show what you should be aware of and how you should refer this patient for further care to an infectious disease doctor or a hepatologist or a gastroenterologist,” Dr. Khalsa said. “Both the addiction expert and the infectious disease docs need to work together on this issue of treating a complex, multidisciplinary medical problem.”