 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Holly Hagan, PhD, NDRI, 71 West 23rd, 8th floor, New York, NY 10010, 212-845-4465, hagan@ndri.org, Mary Latka, PhD, Center for Urban Epidemiologic Studies, New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029, Jennifer Vernon Campbell, MSPH, HIV/AIDS Epidemiology Program, Public Health - Seattle & King County, 106 Prefontaine Place South, Seattle, WA 98104, Elizabeth T. Golub, PhD, Department of Epidemiology, Johns Hopkins University, 627 N. Washington Street, Baltimore, MD 21205, Richard S Garfein, PhD, MPH, Division of HIV/AIDS Prevention, Epidemiology Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, MS E-45, Atlanta, GA 30333, David L. Thomas, MD, MPH, Division of Infectious Diseases, Johns Hopkins School of Medicine, 424 N Bond Street, Baltimore, MD 21205, and Steffanie A. Strathdee, PhD, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205.
Background: Although recent studies have demonstrated feasibility and effectiveness of interferon with ribavirin as treatment for HCV infection in IDUs, treatment access has been low relative to other groups. We studied treatment eligibility according to the 2002 NIH Consensus Guidelines for Management of HCV.
Methods: Eligible subjects included HCV-antibody positive Baltimore, New York and Seattle IDUs aged 18-35 who injected drugs during the prior 6 months. To determine the proportion who may be ineligible for HCV-treatment, we assessed ALT levels and then depression (Centers for Epidemiologic Studies Depression (CES-D) scores >15 or >22), problem drinking (Alcohol Use Disorders Identification Test (AUDIT) score >7 or >9) and recent drug injection.
Results: Of 208 subjects, 50% had CES-D scores >22; 65% had CES-D scores >15. Twenty-nine percent scored >9 on the AUDIT; 39% scored >7. Sixty percent had ALT values above the upper normal limit; 36% had ALTs >2 times the upper normal limit. Mean number of days since last injection was 6.0; 90% had injected during the previous month. Of those with elevated ALTs, 64% may be ineligible for HCV-treatment because of depression (CES-D >22) or problem drinking (AUDIT >9); using more restrictive criteria (CES-D >15, AUDIT >7, injection in past 30 days), the proportion rises to 97%.
Conclusions: Increasing access to HCV-therapy in this population may require concurrently addressing drug use, depression and alcohol use, which are all treatable conditions. Applying recent drug injection as an exclusion criterion would virtually eliminate access to treatment for the young HCV-positive IDUs sampled.
Learning Objectives:
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.