Monthly Archives: January 2018

Appalachia’s Opioid Addiction Continues Wreaking Health Havoc

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

The Northern Kentucky Health Department (NKHD) has reported a 48% increase in new HIV infections in the region in 2017, with 37 new cases compared to 25 in 2016. In 18 of those 37 cases (48.6%), Injection Drug Use (IDU) was listed as a primary risk factor, compared to just 5 of the 25 cases in 2016 (20%). Further analysis of these data show that the IDU-related new infections were concentrated in just two of the region’s four counties – Campbell and Kenton (Northern Kentucky Health Department, 2018).

Whenever a jump in new HIV infections occurs in Appalachia, I say to myself, “THIS! THIS will be our teachable moment! THIS will be the one that forces [state] to take action!” And, a lot of the time, I’m partially correct. The most common refrain I hear when asking state and local healthcare officials about potential HIV outbreaks is, “We don’t want this to be another Scott County, Indiana.”

Sihe HIV outbreak in Scott County, IN in 2015 (Hopkins, 2017) that saw the county’s number of new HIV infections jump from 5 per year to 216 in two years, states all across American and even the Federal government began taking actions to prevent a similar outbreak. In 2016, Congress partially lifted the ban on Federal funding for Syringe Services Programs (SSPs) – a move once thought virtually impossible given the political climate (All Things Considered, 2016). The Scott County outbreak served as a cautionary tale in state run by Conservatives – “It’s time to get with the times.”

Two hands, with one hold a needle

Photo Source: TheBody.com

Of the 18 IDU-related HIV infections, 78% were co-infected with Hepatitis C (Monks, 2018). Increases in new cases of Hepatitis C (HCV) are often the “canary in the coal mine) that leads healthcare professionals to begin more rigorous screening for HIV, particularly in areas of the country where the incidences of prescription opioid and/or heroin abuse are particularly rampant. Unlike the heroin epidemic of the 1970s, the new opioid epidemic of the modern millennium is set in rural and suburban areas of the country. Of the 220 counties identified by the Centers for Disease Control and Prevention (CDC) as being vulnerable to HIV or HCV outbreaks, 56% are in Kentucky, Tennessee, and West Virginia – the states that rank in the top four rates of Hepatitis B and HCV infections in the U.S. (Whalen & Campo-Flores, 2018).

Across the Ohio River from the Northern Kentucky Independent District, in Cincinnati, the city saw a 40% increase in new HIV infections over 2016, with a total of 129 new infections, 28 of which (22%) were IDU-related (Whalen & Campo-Flores).

HEAL Blog will continue to monitor the situation in Northern Kentucky. After all, nobody wants to be the next Scott County, Indiana

References:

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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Advances and Risks for Hepatitis C Patients

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

As our understanding of the Hepatitis C Virus (HCV) increases, we learn more about how the virus affects our bodies and well as develop better diagnostic and treatment tools to screen for and mitigate the comorbidities that arise from untreated HCV. New technologies can be used to test liver fibrosis without invasive biopsy tools – which remain the most effective way to measure liver damage and scarring (fibrosis) – with a high degree of accuracy…under certain conditions. Additionally, further research has indicated that, in addition to the deleterious effects of HCV on the liver, when left untreated, HCV can result in Chronic Kidney Disease (CKD).

Virtual Touch image of the kidney

Photo Source: Siemens

Virtual Touch™ Quantification (VTQ – Siemens) is a noninvasive diagnostic procedure that allows patients to undergo various types of tissue analyses without the need for surgery or biopsies using Acoustic Radiation Force Impulse (ARFI) – a sonographic technique that determines the local mechanical properties of tissue (a fancy way of saying “stiffness”). Essentially, much like an ultrasound during pregnancy, ARFI and VTQ uses a conventional ultrasound probe during abdominal ultrasonography to measure the stiffness of the liver. This is especially effective in patients with ascites – an accumulation of protein-containing (ascitic) fluid within the abdomen – an advancement over the Fibroscan (Transient Elastography – Echosens) which cannot (Bennett, 2018).

The research (Tsukano, et al., 2017) also indicates that skin liver capsule distance (SCD) – the distance between the skin and the liver capsule – corresponded highly with any discrepancies between VTQ and liver biopsy analyses. Patients with a long SCD may receive less accurate results using VTQ. Steatosis, hepatic inflammation, and hepatocyte ballooning have little effect on ARFI measurement failures (Bennett).

Chronic Kidney Disease stages

Photo Source: Sunlight Pharmacy

Another study (Park, et al., 2017) discovered that patients with HCV are at higher risk of developing CKD. The research found that Chronic HCV is associated with extrahepatic manifestations – problems that occur outside the liver, some of which are associated with the immune system, and others seem to be driven by chronic inflammation – with CKD being the most commonly reported extrahepatic condition. Untreated Chronic HCV leads to a 27% increase for developing CKD, while treating the disease using Interferon-based dual, triple, and all-oral Direct Acting Antivirals (DAAs) had a 30% reduction in risk for developing CKD. The researchers indicated that they were “disturbed” to find that 79% of patients with Chronic HCV did not receive treatment (van Paridon, 2018). The increased risk of CKD was more significant in patients age 18-49, compared to adults aged 60≥.

While more research is needed, this should serve as a caution to payors and legislators who have been reluctant to approve treatment methods for HCV patients due to associated short-term expenditures.

References

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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