Efficacy of a comprehensive strategy for the detection and treatment of hepatitis C infection in a population attending addiction centers.

Background and aims: The burden hepatitis C infection in people with history or current drug use suppose a high risk of hepatic complications and transmission infectious disease. This population is poor linked to heath system and is difficult to achieve them and support treatment because they have high rates of lost follow-up. Our aim was to evaluate an intervention for the diagnosis and treatment of chronic hepatitis C and HIV in this population. Methods: Six-hundred and eighty-three people attended in Drugs and Addictions Centers (DAC) were asked to participate in health counseling and provide blood sample for test HCV, HIV, and syphilis from April 2019 to June 2020. Totally 556 subjects were surveyed and tested. All of them were assigned to a patient navigation program to improve health education and linking to the sanitary system. Hepatitis C infection patients were evaluated in an ampliated medical consult to evaluate hepatic stage with transient liver elastography and initiated Direct Acting Antivirals to achieve Sustained Viral Response. Results: Of the 556 patients who agreed to participate in the study, 33 (5.9%) had active HCV infection. Of the 33 patients infected with HCV, three were lost to follow-up once the diagnosis of HCV infection was made. Twenty-eight patients (93.3%) completed treatment and 26 achieved Sustained Viral Response (78.8%). Of the 30 patients, seven (23.3%) had advanced fibrosis, and of these, four (16.6%) had liver cirrhosis. One of the cirrhotic patients had hepatic space-occupying lesions at the baseline evaluation and was diagnosed with hepatocarcinoma. Conclusions: Our study suggests that the implementation of strategies based on personalized intervention models can contribute to the control of HCV infection in DAC users.

Comparison of hepatitis B and SARS-CoV2 vaccination rates in people who attended Drugs and Addiction Centres.

Background and aims: Persons with substance use disorder are at increased risk for hepatitis B virus (HBV) infection. Although most of them are attached to social health centers, the vaccination rate in this group is low. In this context, we designed a study to evaluate the prevalence of users of drug addiction centers (DAC) not immunized against hepatitis B and to compare the rate of vaccination against hepatitis B with the rate of immunization against SARS-Cov-2 in 2 years of follow-up. Design: Retrospective study that included individuals attended at DAC. Patients were screened at baseline (June 2020-January 2021) for HBV immunization. Individuals with HBsAb < 10 IU/mL were recommended to receive hepatitis B vaccine, during follow-up (January 2021-October 2022). At the end of follow-up, the HBV vaccination rate among candidates was determined and compared with the vaccination rate against SARS-Cov-2 in this population in the same period. Findings: A total of 325 subjects were surveyed and tested. At baseline, the 65% (211/325) of were candidates to initiate vaccination and were advisor to HBV vaccination. During the follow-up 15 individuals received at least one dose of HBV vaccine, supposing a vaccination rate of 7.2%. In the same period, 186 individuals received at least one dose against SARS-Cov-2, representing a vaccination rate of 83%. The comparison between vaccination rates reached statistically significant (p < 0.001). Conclusion: Our study manifests a low rate of immunization against HBV in DAC users, despite a high level of immunization for SARS-Cov-2 during the same period in the same population. Consequently, the lack of immunization against HVB in this population might be related with health policy issue more than to individuals linked to care and awareness. A similar approach for vaccination intended for SARS-CoV2 should be applied in high-risk population to warrant the success of immunization program against other preventable diseases such as HBV.

Metadona y efavirenz / No disponible

La interacción de fármacos antirretrovirales con metadona puede producir síntomas de síndrome de abstinencia a metadona (SAM). Este hecho se ha descrito con fármacos de la familia de los inhibidores de la proteasa y con inhibidores de la transcriptas a inversano análogos de los nucleósidos. Efavirenz puede inducir el metabolismo de otros fármacos, que como metadona, son metabolizados en el citocromo P-450, disminuyendo los niveles plasmáticos de los mismos. El manejo de los pacientes con SAM consiste en una escalada de dosis de metadona hasta revertir el cuadro clínico. Los estudios realizados han permitido conocer que la mayor parte de los pacientes con efavirenz y metadona requieren ajuste de dosis de este fármaco, que el incremento medio de metadona para obtener una reversión del SAM es del 25% de la dosis basal, que el control clínico es suficiente para dirigir la escalada de dosis y que la determinación de niveles plasmáticos de metadona no es necesaria para el manejo de los pacientes. La utilización de una estrategia de revertir el SAM supone aceptar que éste se produzca. Ello entraña el riesgo abandono del TARGA por muchos pacientes para evitar la reaparición de un SAM. Por eso, en la actualidad en los centros de terapias aditivas se plantea una estrategia de prevención del SAM en pacientes en programa de metadona que inician tratamiento con efavirenz, mediante un aumento “preventivo” de la dosis de metadona (AU)

The pharmacokinetic interaction between antirretrovirals drugs and methadone can produce an opiods abstinence syndrome (OAS). This fact has been described as protease inhibitors as non-nucleoside transcriptase inverse inhibitors. Efavirenz can induce the metabolism of other drugs, that like methadone, are metabolized in the cytocrome P-450, diminishing the plasmatics levels of such. The treatment of the patients with OAS consists of a scaling of dose of methadone until reverting the symptons. Studies have allowed to know that most of the patients with efavirenz and methadone require adjustment of dose of this drug, the average increase of methadone required to obtain a reversion of AMS is a 25% of the basal dose and that the clinical control is sufficient and the determination of plasmatics levels of methadone is not necessary to direct the scaling of dose of methadone of the patients. The use of a strategy to revert AMS supposes to accept that this one takes place. It involves the risk abandonment of the HAART by many patients to avoid the reappearance of AMS. So, at the present time a strategy of prevention of AMS in patients in program of methadone who initiate treatment with efavirenz, by means of "a preventive" increase of the dose of metadona can be considered (AU)