Search

Background and Aims: Hepatitis C virus (HCV) and alcohol use are patient risk factors for accelerated fibrosis progression, yet few randomized controlled trials have tested clinic-based alcohol interventions., Approach and Results: A total of 181 patients with HCV and qualifying alcohol screener scores at three liver center settings were randomly assigned to the following: (1) medical provider-delivered Screening, Brief Intervention, and Referral to Treatment (SBIRT), including motivational interviewing counseling and referral out for alcohol treatment (SBIRT-only), or (2) SBIRT plus 6 months of integrated colocated alcohol therapy (SBIRT + Alcohol Treatment). The timeline followback method was used to assess alcohol use at baseline and 3, 6, and 12 months. Coprimary outcomes were alcohol abstinence at 6 months and heavy drinking days between 6 and 12 months. Secondary outcomes included grams of alcohol consumed per week at 6 months. Mean therapy hours across 6 months were 8.8 for SBIRT-only and 10.1 for SBIRT + Alcohol Treatment participants. The proportion of participants exhibiting full alcohol abstinence increased from baseline to 3, 6, and 12 months in both treatment arms, but no significant differences were found between arms (baseline to 6 months, 7.1% to 20.5% for SBIRT-only; 4.2% to 23.3% for SBIRT + Alcohol Treatment; P = 0.70). Proportions of participants with any heavy drinking days decreased in both groups at 6 months but did not significantly differ between the SBIRT-only (87.5% to 26.7%) and SBIRT + Alcohol Treatment (85.7% to 42.1%) arms (P = 0.30). Although both arms reduced average grams of alcohol consumed per week from baseline to 6 and 12 months, between-treatment effects were not significant., Conclusions: Patients with current or prior HCV infection will engage in alcohol treatment when encouraged by liver medical providers. Liver clinics should consider implementing provider-delivered SBIRT and tailored alcohol treatment referrals as part of the standard of care., (© 2019 by the American Association for the Study of Liver Diseases.)

Abstract Health care utilization for HIV-1-infected patients appears to be declining in the United States as a result of highly active antiviral therapy (HAART); yet the opposite appears true in the HIV/hepatitis C virus (HCV) coinfected population. The reasons for this difference are not well understood. We examined the rates and reasons for emergency department visits and hospital admissions at an academic tertiary care medical center for HIV/HCV coinfected patients as compared to HIV-1 monoinfected patients, using a retrospective matched cohort study design. HIV/HCV coinfected patients had higher rates of health care utilization (emergency department visits 43.9 versus 7.1 per 100 person-years; hospital admissions 18.2 versus 6.7 per 100 person-years, for HIV coinfected and monoinfected, respectively). This increase was not solely due to liver related events. Instead, comorbidities such as diabetes, renal disease, and psychiatric/substance abuse played a larger role in the health-care utilization in the HIV/HCV coinfected population.

Accurate HCV knowledge is lacking among high-risk groups, including people with HIV/AIDS (PLWHA). Liver disease primarily due to HCV has emerged as a serious cause of mortality among PLWHA. We used an Interrupted Time Series design to evaluate a social-ecologically based intervention for PLWHA, where an infectious disease clinic serving a six-county intervention area was monitored before (7 months) and after (17 months) intervention onset. The intervention included education of PLWHA and medical providers, HIV/HCV support groups, and adaptation of the patient chart top sheet to include HCV test information. Clinic-level outcomes were assessed prospectively every other week for 2 years by interviewing patients (n = 259) with clinic appointments on assessment days. Abrupt, gradual and delayed intervention effects were tested. Weighted regression analyses showed higher average HCV knowledge and a higher prevalence of patients reporting HCV discussion with their medical providers after intervention onset. A delayed effect was found for HCV awareness, and a gradually increasing effect was found for knowing one's HCV status. Other communities may consider adopting this intervention. Additional HCV interventions for PLWHA with HIV are needed.

Background: Durham County, North Carolina, faces high rates of human immunodeficiency virus (HIV) infection (with or without progression to AIDS) and sexually transmitted diseases (STDs). We explored the use of health care services and the prevalence of coinfections, among HIV-infected residents, and we recorded community perspectives on HIV-related issues., Methods: We evaluated data on diagnostic codes, outpatient visits, and hospitalizations for individuals with HIV infection, STDs, and/or hepatitis B or C who visited Duke University Hospital System (DUHS). Viral loads for HIV-infected patients receiving care were estimated for 2009. We conducted geospatial mapping to determine disease trends and used focus groups and key informant interviews to identify barriers and solutions to improving testing and care., Results: We identified substantial increases in HIV/STDs in the southern regions of the county. During the 5-year period, 1,291 adults with HIV infection, 4,245 with STDs, and 2,182 with hepatitis B or C were evaluated at DUHS. Among HIV-infected persons, 13.9% and 21.8% were coinfected with an STD or hepatitis B or C, respectively. In 2009, 65.7% of HIV-infected persons receiving care had undetectable viral loads. Barriers to testing included stigma, fear, and denial of risk, while treatment barriers included costs, transportation, and low medical literacy., Limitations: Data for health care utilization and HIV load were available from different periods. Focus groups were conducted among a convenience sample, but they represented a diverse population., Conclusions: Durham County has experienced an increase in the number of HIV-infected persons in the county, and coinfections with STDs and hepatitis B or C are common. Multiple barriers to testing/treatment exist in the community. Coordinated care models are needed to improve access to HIV care and to reduce testing and treatment barriers.

Objective: Liver disease associated with hepatitis C virus (HCV) is a serious cause of mortality among people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) (PLWHA). Little is known about the HCV knowledge of PLWHA., Methods: One hundred seventy-nine patients at an infectious disease clinic were interviewed on HCV knowledge and alcohol use., Results: Sixty-six percent of participants indicated that HCV is transmitted through blood; 53% indicated that persons with HIV-HCV co-infection can benefit from HCV treatment; and 79% and 74%, respectively, indicated that safer sex and safer injection techniques can prevent HCV transmission. Among PLWHA with self-reported HCV, 97% indicated that persons with HCV should not drink alcohol, but 32% reported using alcohol in the past 30 days., Conclusions: Health education is needed to prevent HCV infections and increase HCV treatment-seeking. Higher education levels were related to more accurate HCV knowledge, indicating the need for health promotion for PLWHA of lower education levels.

The interplay between positive and negative emotions during alcohol treatment is complex. We aimed to evaluate the relationship between alcohol reductions and changes in positive and negative emotions across a one-year period. Chronic HCV patients (n = 174) with alcohol use received brief alcohol counseling and were encouraged to address their alcohol use. Participants completed the Positive and Negative Affect Schedule (PANAS)-Short Form, the Mental Health Continuum-Short Form, and the Alcohol Timeline Follow-back at baseline and 3, 6, and 12 months. Decreases in alcohol use were related to decreased negative emotions from baseline to 3 months, baseline to 6 months and baseline to 12 months. Decreases in alcohol use were associated with increased positive emotions from baseline to 12 months but not sooner. [ABSTRACT FROM AUTHOR]

Alcohol consumption in the setting of chronic HCV is associated with accelerated progression towards cirrhosis, increased risk of hepatocellular carcinoma and higher mortality. This analysis contextualizes how sociodemographic factors, chronic pain and depression relate to the motivations of individuals with chronic HCV to consume alcohol. We conducted a secondary analysis of baseline data from the Hep ART trial of behavioural interventions on alcohol use among patients with HCV. Alcohol consumption was measured using the Drinking Motives Questionnaire and a novel 6‐item measure of pain‐related drinking motives. Statistical analyses performed included ANOVA for bivariate analyses and multivariable ordinary least‐squares linear regression. At study baseline, 181 participants had an average age of 55 years; the majority (66.7%) reported beyond‐minor pain; and a third (37%) met criteria for depression; drinking motives were higher for individuals with beyond‐minor pain (means 9.9 vs. 4.6, p <.001) and who met criteria for depression (means 10.9 vs. 6.4, p <.001) when using the pain‐related drinking motives items. Average pain(coef = 1.0410067141 <.001) was significantly associated with increased motives to drink to relieve pain in the full baseline model specification controlling for all covariates using ordinary at least squares; depression (coef = 7.06; 95% CI 1.32, 12.81; p =.016) was significantly associated with increased non‐pain‐related motives to drink. From baseline to 3‐month follow‐up, compared to participants who had mean average pain scores among the sample, motives to drink to relieve pain decreased in participants who had higher average pain scores (coef = −0.30; 95% CI −0.59, −0.01; p =.40). Physical pain and depression are associated with increased motives to consume alcohol. Patients with chronic liver disease should be screened for chronic pain and depression and, if present, referred to pain specialists or co‐managed in partnership with pain specialists in hepatology clinics. [ABSTRACT FROM AUTHOR]

Abstract Introduction Among patients with hepatitis C virus (HCV) infection, alcohol synergistically increases the risk of cirrhosis, hepatocellular carcinoma, and death. Randomized controlled trials of integrated models of HCV-alcohol treatment have been recommended but only performed in patients with severe alcohol use disorders. Objectives This pragmatic randomized controlled trial seeks to compare clinical effectiveness and cost-effectiveness of integrated alcohol treatment compared to enhanced treatment as usual (TAU) on alcohol consumption and economic outcomes among patients ever infected with HCV. Methods Patients recruited from three liver centers who had current or prior chronic HCV and qualifying alcohol screener scores were randomly assigned to enhanced TAU or the Hepatitis C-Alcohol Reduction Treatment (Hep ART) intervention. All patients received enhanced TAU, consisting of a patient-administered alcohol screener and care from medical providers who were trained in Screening, Brief Intervention and Referral to Treatment (SBIRT), including brief motivational interviewing counseling. The Hep ART intervention combined enhanced TAU with up to six months of integrated co-located individual and/or group therapy that provided motivational, cognitive, and behavioral strategies to reduce alcohol consumption. The Timeline Followback (TLFB) Method was used to evaluate alcohol use at baseline, 3, 6, and 12 months. Primary outcomes are alcohol abstinence and fewer heavy drinking days, and for the cost-effectiveness analysis, measures included grams of alcohol consumed. Discussion This study will determine whether Hep ART, a six-month integrated alcohol treatment, compared to enhanced TAU, is both clinically effective and cost-effective in patients with a history of comorbid HCV and alcohol use. [ABSTRACT FROM AUTHOR]

The article examines the development of the HCV-alcohol Knowledge Scale, a measure of knowledge of the link between hepatitis C virus (HCV) and alcohol use. Topics discussed include assessment of the measure's ability to identify changes in HCV-alcohol knowledge after being exposed to HCV-alcohol education and the determination of demographic characteristics linked to HCV-alcohol knowledge to inform targeting HCV-alcohol knowledge interventions to certain sub-groups.

The increased mortality among persons co-infected with HIV/AIDS and hepatitis C (HCV) is a concern that provider training on HCV-HIV co-infection may address. Medical and behavioral health providers were given training on co-infection. This study addresses two research questions: What changes, if any, did providers seek to effect in their practice after training? Of those providers desiring change in their practice, which, if any, did they implement? Surveys indicated that 82% planned to change their practice. Of those, 51% were reached 3 months later, and of those, 86% reported having enacted a change. Qualitative analysis found that planned changes fell into two domains: HCV Education and HCV Medical Actions. The most frequently intended and enacted changes involved patient education. Barriers to enact changes included lack of colleague support for HCV treatment and inadequate access to hepatitis A/B vaccine. Training on HIV-HCV co-infection should: engage multiple providers from the same site; address HCV treatment side effects; and support systems changes targeting vaccine and testing availability. [ABSTRACT FROM AUTHOR]