title: Delivering care to injection drug users coinfected with HIV and hepatitis C virus.
abstract: Injection drug use has fueled the epidemic of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) coinfection in the United States. Nevertheless, drug dependence is among the main reasons that coinfected persons are not being treated for HCV infection. This report describes the development and progress of an HIV clinic program (funded by the Ryan White Comprehensive AIDS Resources Emergency Act) to deliver care for HCV infection to HIV-seropositive injection drug users. To optimize safety and adherence, pegylated interferon is directly administered to patients in the context of integrated addiction, psychiatric, and HIV and HCV therapy. Ribavirin is packed weekly in pill boxes for patients to take at home. Thus far, adherence to weekly visits for treatment with interferon has been 99%. No one has had to stop treatment for HCV infection because of ongoing drug use, addiction relapse or exacerbation, or psychiatric complications. Presented here is a work in progress, rather than a finished research project or definitive model of care.
authors.affiliation: Department of Medicine, Division of Infectious Disease, Brown Medical School, Providence, Rhode Island, USA. ltaylor@lifespan.org
authors.forename: Lynn E
authors.initials: LE
authors.lastname: Taylor
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D004608:Eligibility Determination / Q000592:standards; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000628:therapy*; D006297:Health Services Accessibility; D006526:Hepatitis C / Q000150:complications* / Q000628:therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011994:Recombinant Proteins; D012237:Rhode Island; D012254:Ribavirin / Q000627:therapeutic use; D015819:Substance Abuse, Intravenous / Q000150:complications*; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a