Tag Archives: Michigan Department of Health & Human Services

HHS Releases New HIV Treatment Guidelines

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 Department of Health and Human Services released updated Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV in October 2017, which included updates for best practices, treatment protocols and recommendations, which drugs not to use, treatment for virologic failure, regimen switching, adherence to the continuum of care, drug interactions, and Hepatitis B (HBV) and Hepatitis C (HCV) co-infection treatment guidelines.

Because emtricitabine (FTC – Truvada, Descovy, Stribild, Genvoya, Odefsey), lamivudine (3TC – Epivir, Epivir-HBV, Combivir, Kivexa, Trizivir), tenofovir disoproxil fumarate (TDF- Viread, Atripla, Complera, Stribild, Truvada), and tenofovir alafenamide (TAF – Genvoya, Odefsey, Descovy) have activity against both HIV and HBV, an Antiretroviral Therapy (ART) should include (TAF or TDF) plus (3TC of FTC) to fully suppress the viruses. Other HBV treatment regimens, including adefovir (Hepsera) alone or in combination with 3TC or FTC, are not recommended for patients co-infected with HIV/HBV.

Rx pill bottles and pills

Photo Source: HIVThrive.Com

HBV reactivation has been observed in persons with HBV infection during interferon-free HCV treatment. For that reason, all patients initiating HCV therapy should be tested for HBV. Persons with HCV/HIV coinfection and active HBV infection should receive two agents with anti-HBV activity prior to initiating HCV therapy.

For HCV, ART may slow the progression of liver disease related to HCV by preserving or restoring immune function and reducing HIV-related immune activation and inflammation. For most persons with HCV/HIV coinfection, including those with cirrhosis, the benefits of ART outweigh concerns regarding drug-induced liver injury. Therefore, ART should be initiated in all patients with HCV/HIV coinfection, regardless of CD4 T-cell count. All patients with HCV/HIV coinfection should be evaluated for HCV therapy and have their liver fibrosis stage assessed to inform the length of their therapy, ribavirin need (a concern with some regimens), and subsequent risk of hepatocellular carcinoma and liver disease complications

The document also includes an extensive list of the various drug interactions between HIV and HCV drugs, including the three newest HCV regimens, Epclusa, Vosevi, and Mavyret. HEAL Blog previously covered HCV and HIV drug interactions (Hopkins, 2016). While the document is clearly meant for medical and other healthcare professionals, if you would like more information, please check out the link below in the citation.

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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Opioid State of Emergency Muddies the Waters

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

On July 31st, 2017, President Trump’s Commission on Combating Drug Addiction and the Opioid Crisis put forth its recommendations for combating the opioid epidemic in the United States. It’s “first and most urgent recommendation:” “…declare a national emergency under either the Public Health Service Act or the Stafford Act” (Ingraham, 2017). The President was quick to react, promising he would do so. It only took nearly three months, but he followed through with as much forethought and careful planning as every other venture in this administration. That is to say, it did not go very well.

One of the biggest frustrations with the Trump Administration has been its members’ tendency to act with seemingly no real concern or knowledge of existing programs and systems already in place, or of any complications or repercussions their decrees and executive orders may create. Moreover, getting him to follow through on any of his promises always seems to require a Herculean effort that inevitably involves constant hounding, public comments, and eventual media shaming. Even then, after being raked over the coals, when he does act, it always seems to fall short of actually meaning or doing anything. Thus is the case with last week’s announcement of a quite limited “Public Health Emergency.”

Using the Public Health Service Act, the President declared on October 26th, 2017, a not-so-sweeping “Public Health Emergency” in an effort to combat the opioid epidemic (Johnson & Wagner, 2017). This declaration orders acting Acting-Secretary of Health and Human Services Eric Hargan to waive regulations and give states more flexibility in how they use Federal funds (Korte, 2017). It also allows the U.S. Department of Health and Human Services (DHHS) to work around what the administration calls “…bureaucratic delays and inefficiencies in the hiring process” to temporarily appoint specialists to deal with the crisis. In addition, it allows for expanded access to telemedicine services, including services involving remote prescribing of medicine commonly used for substance abuse or mental health treatment.

President Donald Trump shakes hands with New Jersey Gov. Chris Christie after signing a presidential memorandum to declare the opioid crisis a national public health emergency in the East Room of the White House, Thursday, Oct. 26, 2017, in Washington. (AP Photo/Pablo Martinez Monsivais)

Photo Source: AP Photo/Pablo Martinez Monsivais

Most troubling, the action specifically:

“…allows for shifting of resources within HIV/AIDS programs to help people eligible for those programs receive substance abuse treatment, which is important given the connection between HIV transmission and substance abuse.”

This is particularly alarming, given the fact that the programs that provide coverage for the treatment of HIV in lower-income patients – namely the Ryan White program – already allow funds to be used for outpatients substance abuse treatment and rehabilitation services under both Title I and Title II. That being the case, the inclusion of this language in last week’s declaration sparked a panic within the HIV services and advocacy communities as they attempted to parse exactly what the declaration meant, as well as which programs were at risk of having their funding reallocated for another purpose. Other HIV/AIDS programs beyond treatment coverage include prevention efforts, research, data mining, and efforts at the CDC. Are those on the chopping block, now?

Perhaps the most oft-repeated refrain of 2017 has been, “We just don’t know.” Virtually every action by the Trump administration has left every department responding to almost every question about intents, implications, or repercussions by saying, “We just don’t know.” This holds true for the public health emergency declaration:

From where is the funding for these programs going to come? “We just don’t know.” Senator Richard Blumenthal (D-CT) said the measure won’t be sufficient for most states. In Connecticut, the President’s move would free up only $57,000 in additional public health funds (Firger, 2017).

What temporary appointments can or will be made within the DHHS? “We just don’t know.” Many of the experts in these fields are either already working within the government or are working for other governments in nations where Harm Reduction is actively funded and healthcare is universally provided.

How does this declaration plan to increase access to telemedicine, and how will that access work without being connected to other recovery services? “We just don’t know.” Many of the most affected regions in the country are in areas where rehabilitation and recovery services are already sparse, and medication-assisted treatment for substance abuse is intended to be used in conjunction with those services. And, again, how will we pay for all of this? “We just don’t know.”

The President’s partial measure in announcing a public health emergency rather than a national emergency seems arbitrary to most people, but had he done the latter under the Stafford Act, that would have opened up resources that are usually reserved for natural disasters (i.e. – FEMA’s disaster relief fund) and states could have requested Federal grants for those purpose. Instead, we got an unfunded half-measure that includes some rather terrifying implications for HIV/AIDS programs, and a “Fact Sheet” about the declaration, half of which was comprised of self-congratulatory back pats instead of a detailed and specific plan for moving forward with this declaration.

Perhaps the most telling part of the aforementioned Fact Sheet was the introductory quote at the top of the page:

“The best way to prevent drug addiction and overdose is to prevent people from abusing drugs in the first place.  If they don’t start, they won’t have a problem.” – President Donald J. Trump  

Well. That certainly clears things up for everybody.

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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Michigan Hepatitis C Surge Related to Prescription Opioid and Heroin Abuse

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 Michigan Department of Health and Human Services (MDHHS) released its 2016 Hepatitis B and C Annual Surveillance Report, indicating drastic increasing in new Chronic Hepatitis C (HCV) cases in the state, particularly among residents aged 18-29. Two factors posed significant roles in the transmission of these cases – Injection Drug Use (IDU) and Incarceration.

HEAL Blog has consistently reported on HCV transmission as a result of IDU and within incarceration settings, and report is further evidence of those positions. There were 11,883 new Chronic HCV cases reported in 2016 for a rate of 119.78 out of every 100,000 people. 69% of those cases were followed up on and epidemiological profiles were made; of those IDU was a risk factor in 64% of cases, while incarceration was a risk factor in 63% (MDHHS, 2017).

More striking, however, was the vast increase in Chronic HCV in people aged 18-29 between 2005-2016 – an alarming 473%, of which 84.2% were reportedly related to IDU in that same age group. This trend is replicated all over the country, especially in areas where prescription opioid and heroin abuse levels are more prevalent.

Logo for the Michigan Department of Health & Human Services

Photo Source: MDHHS

MDHHS reported that viral hepatitis-related hospitalizations, liver cancer incidence, liver transplants, and viral hepatitis deaths have all increased over the last decade, largely driven by the impact of Chronic HCV infections (Mack, 2017). With so many of these cases ostensibly linked to opioid and heroin abuse, a robust response to the addiction epidemics is needed, as well as compulsory “Opt-Out” screening at clinics, emergency rooms, hospitals, and correctional settings.

The Lansing City Council recently voted to allow Syringe Services Programs (Syringe/Needle Exchanges), a proactive Harm Reduction measure that studies indicate reduces the rate of transmission amongst both People Who Inject Drugs (PWIDs), as well as the general population (Cook, 2017). Selling these programs to citizens who are unfamiliar with the programs, staunchly opposed to drug use, or believe that the exchanges encourage drug use remains a difficult proposition. Proponents argue that PWIDs are going to use drugs, regardless of whether or not there are exchanges; that being the case, it makes logical sense to prevent the spread of disease.

Michigan’s increase in Viral Hepatitis (VH) follows a national trend that will be replicated – possibly with farther reaching, deadlier impact – in other states.

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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