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Specka M, Kröckert T, Trilling M, Bonnet U, Schifano F, Scherbaum N. Opiate maintenance patients' attitudes and self-reported adherence to protective measures against SARS-CoV-2 infections. Front Psychiatry 2023; 14:1254053. [PMID: 37779618 PMCID: PMC10539610 DOI: 10.3389/fpsyt.2023.1254053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Background During the COVID-19 pandemic we assessed to which extent patients in opioid maintenance treatment (OMT) adhere to official recommendations regarding preventive intervention strategies against COVID-19. Methods Patients enrolled in two OMT clinics in Germany were interviewed applying a standardized questionnaire, which covered socio-demographic information, recent psychotropic substance use, recent social activities, the history of SARS-CoV-2 infection, attitudes toward official protection recommendations, and levels of adherence to these suggestions. Current mental and medical diagnoses were retrieved from medical files. In subjects without known infection and without vaccination, blood samples were tested for the identification of anti-SARS-CoV-2-S-antibodies. Interviews were performed between the end of May and the end of September 2021. Results Patients' (n = 155) average age was 47 years; 74% were males. In addition to the opiate dependence, in nearly 80% of cases another medical disorder was recorded. The range of medical factors that predispose for severe COVID-19 outcomes were present in 39% of patients; 18% of the sample refused to be vaccinated. Nearly all patients reported having carried out a range of activities outside their residence during the week prior to the interviews, including visits of treatment facilities (86.5%; 95% confidence interval [80.2%; 91.0%]) or meeting with friends (64.5% [65.7-71.6%]). Despite the fact that only about 47.1% [39.2%; 55%] felt well informed about measures against infection, adherence to COVID-19 countermeasures was generally high: 83.9% [77.3; 88.8%] claimed to have worn face masks always/nearly always; social distancing was performed always/nearly always by 58.7% [50.8%; 66.2%]; and hand hygiene was conducted by 64.5% [56.7%; 71.6%] of participants. None out of n = 25 tests from unvaccinated subjects was positive for anti-SARS-CoV-2-S-antibodies. Psychiatric comorbidity and educational degree were not statistically significantly associated with attitudes and compliance, except that patients with lower education felt relatively worse informed. Conclusion Self-reported adherence to recommended non-therapeutic intervention strategies and vaccination rates were similar to the German general population. Provision of more health-related information tailored to OMT patients appears necessary.
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Affiliation(s)
- Michael Specka
- Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Tobias Kröckert
- Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Mirko Trilling
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Udo Bonnet
- Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Medical Faculty, University of Duisburg-Essen, Essen, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, Essen, Germany
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, United Kingdom
| | - Norbert Scherbaum
- Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Medical Faculty, University of Duisburg-Essen, Essen, Germany
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Feng Y, Yao T, Gao Y, Li H, Dong S, Wu Y, Liu Y, Li J, Liu C, Liu J, Xue T, Yuan Y, Wu J, Wang F, Liang X, Wang S. Immunogenicity, safety, and compliance of high- and standard-strength four-dose hepatitis B vaccination regimens in patients receiving methadone maintenance therapy in China: a randomized, parallel-arm controlled trial. Expert Rev Vaccines 2021; 20:1629-1635. [PMID: 34503367 DOI: 10.1080/14760584.2021.1977629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND We evaluated the safety and immunogenicity of four doses of 20 or 60 µg, and the immunogenicity and compliance of the short-term vaccination regimen (0, 1, and 2 months) among patients receiving MMT. RESEARCH DESIGN AND METHODS We conducted a randomized controlled trial among 303 patients receiving MMT who were randomized to receive 3 or 4 doses of 20 or 60 µg of recombinant hepatitis B vaccine. RESULTS At month 7, the seroconversion rates in both IM20 × 4 and IM60 × 4 groups were numerically higher than the IM20 × 3 group (P > 0.05). The high-level responses and geometric mean concentration (GMC) of anti-HBs in both IM20 × 4 and IM60 × 4 groups were significantly higher than the IM20 × 3 group (P < 0.05). The completion rate of the short-term high-strength vaccination group was significantly higher than the standard vaccination group (P < 0.05), with similar immunogenicity (P > 0.05). CONCLUSIONS Both the high-strength and standard-strength four-dose hepatitis B vaccine regimens could improve the immune response for patients receiving MMT. The high-strength short-term vaccination regimen could improve compliance and attain comparable immunogenicity with the standard vaccination regimen. The high-strength short-term vaccination regimen is recommended and the fourth dose is encouraged for this population considering the compliance and immunogenicity. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov (NCT03962816).
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Affiliation(s)
- Yongliang Feng
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China.,Center of Clinical Epidemiology and Evidence Based Medicine, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Tian Yao
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China.,Center of Clinical Epidemiology and Evidence Based Medicine, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yizhuo Gao
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China.,Center of Clinical Epidemiology and Evidence Based Medicine, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Hong Li
- Shanxi Provincial Center for Disease Control and Prevention, Taiyuan, Shanxi, China
| | - Shuang Dong
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China.,Center of Clinical Epidemiology and Evidence Based Medicine, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yuanting Wu
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China.,Center of Clinical Epidemiology and Evidence Based Medicine, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yuan Liu
- Methadone Maintenance Treatment Clinic, Compulsory Isolation Drug Rehabilitation Center, Taiyuan, Shanxi, China
| | - Jing Li
- Methadone Maintenance Treatment Clinic, Compulsory Isolation Drug Rehabilitation Center, Taiyuan, Shanxi, China
| | - Chunhua Liu
- Methadone Maintenance Treatment Clinic, Compulsory Isolation Drug Rehabilitation Center, Taiyuan, Shanxi, China
| | - Jinxia Liu
- Xinghualing District Methadone Maintenance Treatment Clinic, Taiyuan, Shanxi, China
| | - Tongchuan Xue
- Xinghualing District Methadone Maintenance Treatment Clinic, Taiyuan, Shanxi, China
| | - Yuan Yuan
- Methadone Maintenance Treatment Clinic, 109 Hospital, Taiyuan, Shanxi, China
| | - Junhua Wu
- Methadone Maintenance Treatment Clinic, 109 Hospital, Taiyuan, Shanxi, China
| | - Fuzhen Wang
- Chinese Center for Disease Control and Prevention, Beijing, PR China
| | | | - Suping Wang
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China.,Center of Clinical Epidemiology and Evidence Based Medicine, Shanxi Medical University, Taiyuan, Shanxi, China
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3
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Pravetoni M, Comer SD. Development of vaccines to treat opioid use disorders and reduce incidence of overdose. Neuropharmacology 2019; 158:107662. [PMID: 31173759 DOI: 10.1016/j.neuropharm.2019.06.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/01/2019] [Accepted: 06/02/2019] [Indexed: 02/06/2023]
Abstract
Vaccines offer a promising therapeutic strategy to treat substance use disorders (SUD). Vaccines have shown extensive preclinical proof of selectivity, safety, and efficacy against opioids, nicotine, cocaine, methamphetamine, and designer drugs. Despite clinical evaluation of vaccines targeting nicotine and cocaine showing proof of concept for this approach, no vaccine for SUD has yet reached the market. This review first discusses how vaccines for treatment of opioid use disorders (OUD) and reduction of opioid-induced fatal overdoses fit within the current medication assisted treatment (MAT) portfolio, and then summarizes ongoing efforts toward translation of vaccines targeting heroin, oxycodone, fentanyl, and other opioids. This article is part of the Special Issue entitled 'New Vistas in Opioid Pharmacology'.
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Affiliation(s)
- Marco Pravetoni
- University of Minnesota Medical School, Departments of Pharmacology and Medicine, Minneapolis, MN, USA; Hennepin Healthcare Research Institute, Minneapolis, MN, USA.
| | - Sandra D Comer
- Columbia University Irving Medical Center, Department of Psychiatry, The New York State Psychiatric Institute, New York, NY, USA
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4
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Raleigh MD, Peterson SJ, Laudenbach M, Baruffaldi F, Carroll FI, Comer SD, Navarro HA, Langston TL, Runyon SP, Winston S, Pravetoni M, Pentel PR. Safety and efficacy of an oxycodone vaccine: Addressing some of the unique considerations posed by opioid abuse. PLoS One 2017; 12:e0184876. [PMID: 29194445 PMCID: PMC5711015 DOI: 10.1371/journal.pone.0184876] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/01/2017] [Indexed: 11/19/2022] Open
Abstract
Among vaccines aimed at treating substance use disorders, those targeting opioids present several unique medication development challenges. 1) Opioid overdose is a common complication of abuse, so it is desirable for an opioid vaccine to block the toxic as well as the addictive effects of opioids. 2) It is important that an opioid vaccine not interfere with the action of opioid antagonists used to reverse opioid overdose or treat addiction. 3) Some opioids are immunosuppressive and chronic ongoing opioid use could interfere with vaccine immunogenicity. 4) Although antibody-bound oxycodone is unable to enter the brain because of its size, it might still be able to activate peripheral opioid receptors. To assess vaccine impact on opioid toxicity, rats vaccinated with oxycodone conjugated to keyhole limpet hemocyanin subunit dimer (OXY-dKLH) adsorbed to alum or controls vaccinated with dKLH were compared with regard to oxycodone-induced hotplate analgesia and oxycodone-induced respiratory depression and bradycardia. Vaccination shifted the dose-response curves to the right, representing protection, for each of these endpoints. Naloxone was equally effective in both OXY-dKLH and control groups, providing complete and rapid reversal of respiratory depression. The administration of a long-acting naltrexone formulation during vaccination did not impair vaccine immunogenicity in mice. Similarly, serum anti-oxycodone antibody titers were not altered by continuous morphine infusion during vaccination compared to opioid-naïve controls. Competitive ELISA assay showed negligible or low affinity of immune antiserum for endogenous opioids or opioid antagonists. In vitro receptor binding assays showed that antibody-bound oxycodone does not activate mu opioid receptors. These data support further study of OXY-dKLH as a potential treatment for oxycodone abuse and suggest that vaccination might also reduce the severity of oxycodone overdose.
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Affiliation(s)
- M. D. Raleigh
- Minneapolis Medical Research Foundation, Minneapolis, MN, United States of America
- * E-mail:
| | - S. J. Peterson
- Minneapolis Medical Research Foundation, Minneapolis, MN, United States of America
| | - M. Laudenbach
- Minneapolis Medical Research Foundation, Minneapolis, MN, United States of America
| | - F. Baruffaldi
- Minneapolis Medical Research Foundation, Minneapolis, MN, United States of America
| | - F. I. Carroll
- Research Triangle Institute, Research Triangle Park, NC, United States of America
| | - S. D. Comer
- New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, United States of America
| | - H. A. Navarro
- Research Triangle Institute, Research Triangle Park, NC, United States of America
| | - T. L. Langston
- Research Triangle Institute, Research Triangle Park, NC, United States of America
| | - S. P. Runyon
- Research Triangle Institute, Research Triangle Park, NC, United States of America
| | - S. Winston
- Winston Biopharmaceutical Consulting, Boulder, CO, United States of America
| | - M. Pravetoni
- Minneapolis Medical Research Foundation, Minneapolis, MN, United States of America
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, United States of America
- Center for Immunology, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - P. R. Pentel
- Minneapolis Medical Research Foundation, Minneapolis, MN, United States of America
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, United States of America
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Shi J, Feng Y, Gao L, Feng D, Yao T, Shi S, Zhang Y, Liang X, Wang S. Immunogenicity and safety of a high-dose hepatitis B vaccine among patients receiving methadone maintenance treatment: A randomized, double-blinded, parallel-controlled trial. Vaccine 2017; 35:2443-2448. [PMID: 28343774 DOI: 10.1016/j.vaccine.2017.03.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 03/10/2017] [Accepted: 03/10/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS To explore whether the immunization with high-dose (60μg) hepatitis B vaccines in patients receiving methadone maintenance treatment (MMT) could yield a superior protection against hepatitis B infection than did the standard dose (20μg). METHODS We conducted a randomized, double-blinded, parallel-controlled trial in MMT patients. Patients with serologically negative hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (anti-HBs) were randomized in a ratio of 1:1 to receive three intramuscular injections of 20μg or 60μg recombinant hepatitis B vaccine at months 0, 1, and 6. Serum HBsAg and anti-HBs were measured at months 7 and 12 post-vaccination to assess the immunogenicity. RESULTS A total of 196 MMT patients were randomized and 195 received at least one injection (98 and 97 in 20 and 60μg vaccine groups, respectively). The 60μg vaccine group showed a seroconversion of anti-HBs of 87.3%, high-level response rate of 56.3%, and GMC of 742.9mIU/mL at month 7. While these results were numerically higher than the 20μg group, a statistical difference was not found. HIV infection and concomitant drug abuse were negatively associated with the robust immune responses. 7.7% of MMT patients receiving at least one dose of vaccine reported solicited adverse reactions within 7days after vaccination, 2.6% reported unsolicited adverse reactions within 28days after vaccination. None of the MMT patients reported serious adverse events or became HBsAg positive during the follow-up. CONCLUSIONS The three-dose regimen of 60μg recombinant hepatitis B vaccine at months 0, 1, and 6 can yield a similar immunogenicity among MMT patients as compared to the 20μg vaccine. ClinicalTrials.gov identifier: NCT02991599.
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Affiliation(s)
- Jing Shi
- School of Public Health, Shanxi Medical University, Taiyuan 030001, Shanxi, China
| | - Yongliang Feng
- School of Public Health, Shanxi Medical University, Taiyuan 030001, Shanxi, China
| | - Linying Gao
- School of Public Health, Shanxi Medical University, Taiyuan 030001, Shanxi, China
| | - Dan Feng
- School of Public Health, Shanxi Medical University, Taiyuan 030001, Shanxi, China
| | - Tian Yao
- School of Public Health, Shanxi Medical University, Taiyuan 030001, Shanxi, China
| | - Shan Shi
- Methadone Maintenance Treatment Clinic, Nanning Red Cross Hospital, Nanning, Guangxi, China
| | - Yawei Zhang
- Yale School of Medicine, New Haven 06510, CT, USA
| | - Xiaofeng Liang
- Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Suping Wang
- School of Public Health, Shanxi Medical University, Taiyuan 030001, Shanxi, China.
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6
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Factors associated with hepatitis B vaccine series completion in a randomized trial for injection drug users reached through syringe exchange programs in three US cities. BMC Public Health 2014; 14:820. [PMID: 25107530 PMCID: PMC4138371 DOI: 10.1186/1471-2458-14-820] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 07/29/2014] [Indexed: 11/10/2022] Open
Abstract
Background Hepatitis B virus (HBV) is a vaccine preventable infection yet vaccination rates are low among injection drug users (IDUs) despite the high risk of infection and longstanding recommendations to promote vaccination. We sought to improve vaccination rates by reaching IDUs through syringe exchange programs (SEPs) in three U.S. cities. Methods IDUs were randomized in a trial comparing the standard HBV vaccination schedule (0, 1, and 6 months) to an accelerated schedule (0, 1, and 2 months) and participation data were analyzed to identify determinants of completion of the three-dose vaccine series. Independent variables explored included sociodemographics, injection and syringe access behaviors, assessment of health beliefs, HBV-associated knowledge, and personal health status. Results Covariates associated with completion of the three-dose vaccine series were accelerated vaccine schedule (aOR 1.92, 95% CI 1.34, 2.58, p = <0.001), older age (aOR 1.05, 95% CI 1.03, 1.07, p = <0.001), and poorer self-rated health score (aOR 1.26, 95% CI 1.05, 1.5, p = 0.02). Completion was less likely for those getting syringes from SEP customers than for SEP customers (OR 0.33, 95% CI 0.19, 0.58, p = <0.001). Conclusions SEPs should offer hepatitis vaccination in a manner that minimizes time between first and last visits by accelerating the dosing schedule. Public health interventions should target younger, less healthy, and non-SEP customer participants. Other health interventions at SEPs may benefit from similar approaches that reach out beyond regular SEP customers.
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7
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Immune response to hepatitis B vaccination in drug using populations: A systematic review and meta-regression analysis. Vaccine 2014; 32:2265-74. [DOI: 10.1016/j.vaccine.2014.02.072] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 12/31/2013] [Accepted: 02/25/2014] [Indexed: 11/17/2022]
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Brook G, Main J, Nelson M, Bhagani S, Wilkins E, Leen C, Fisher M, Gilleece Y, Gilson R, Freedman A, Kulasegaram R, Agarwal K, Sabin C, Deacon-Adams C. British HIV Association guidelines for the management of coinfection with HIV-1 and hepatitis B or C virus 2010. HIV Med 2010; 11:1-30. [PMID: 20059574 DOI: 10.1111/j.1468-1293.2009.00781.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- G Brook
- British HIV Association (BHIVA), BHIVA Secretariat, Mediscript Ltd, London, UK.
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9
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Nyamathi A, Sinha K, Greengold B, Cohen A, Marfisee M. Predictors of HAV/HBV vaccination completion among methadone maintenance clients. Res Nurs Health 2010; 33:120-32. [PMID: 20143328 DOI: 10.1002/nur.20371] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This randomized, controlled study (N = 256) was conducted to compare three interventions designed to promote hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccination completion among clients undergoing methadone maintenance (MM) treatment. Participants were recruited from five MM treatment sites in Southern California and randomized into three groups: Motivational Interviewing-Single (MI-Single), Motivational Interviewing-Group (MI-Group); and Nurse-Led Hepatitis Health Promotion (HHP). All were offered the three-series HAV/HBV vaccine. A total of 148 participants completed the vaccine. Groups did not differ in rate of vaccination completion (73.6%, HHP group, vs. 65% and 69% for the MI-Single and MI-Group, respectively). The equivalence of findings across groups suggests the value of including nurses with a comprehensive health focus in promoting vaccination completion.
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Affiliation(s)
- Adeline Nyamathi
- School of Nursing, University of California-Los Angeles, Box 951702, Los Angeles, CA 90095-1702, USA
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10
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Semaan S, Neumann MS, Hutchins K, D'Anna LH, Kamb ML. Brief counseling for reducing sexual risk and bacterial STIs among drug users--results from project RESPECT. Drug Alcohol Depend 2010; 106:7-15. [PMID: 19720471 DOI: 10.1016/j.drugalcdep.2009.07.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Revised: 06/30/2009] [Accepted: 07/16/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Project RESPECT's brief risk reduction counseling (BRRC) reduced sexual risk and bacterial STIs among at-risk heterosexuals and has been packaged for use with this population. We assessed BRRC's efficacy with RESPECT participants who used drugs and examined BRRC's applicability to present-day users of heroin, cocaine, speedball, or crack. METHODS We compared baseline demographic and economic variables, risk behaviors, and prevalence and correlates of bacterial STIs for ever-injectors ([EIs], N=335) and never-injectors ([NIs], N=3963). We assessed changes in risk behaviors and bacterial STIs for EIs and NIs at 12 months. We compared prevalence of HSV-2, hepatitis B core antigen virus (HBV), hepatitis C virus (HCV), and trichomonas among EIs with recently reported rates among drug users. RESULTS At baseline, 19% of EIs and 29% of NIs had bacterial STIs. Both groups had similar baseline STI correlates. At 12 months, 4% of EIs and 7% of NIs had bacterial STIs. Twelve-month cumulative incidence of bacterial STIs in BRRC was 21% lower among EIs and 18% lower among NIs compared to the informational condition. At 12 months, EIs reported fewer sexual risk behaviors than at baseline. Baseline positivity rates of trichomoniasis in EIs (female: 15%) and in male and female EIs of HSV-2 (39%, 68%), HBV (41%, 37%), and HCV (60%, 58%) were similar to rates in present-day drug users. CONCLUSION Efficacy of BRRC in reducing sexual risk and bacterial STIs in EIs, and similar profiles for EIs and present-day drug users suggest evaluating BRRC with present-day drug users.
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Affiliation(s)
- Salaam Semaan
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Office of the Director, 1600 Clifton Rd, NE, E-07, Atlanta, GA 30333, United States.
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Kreek MJ, Talal AH, Piccolo P. Treating chronic hepatitis C in recovering opiate addicts: yes, we can. Dig Liver Dis 2009; 41:308-10. [PMID: 19233749 PMCID: PMC2778039 DOI: 10.1016/j.dld.2009.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Accepted: 01/10/2009] [Indexed: 12/11/2022]
Affiliation(s)
- M J Kreek
- The Laboratory of the Biology of Addictive Diseases, The Rockefeller University, New York, NY, USA.
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Sunthornchart S, Linkins RW, Natephisarnwanish V, Levine WC, Maneesinthu K, Lolekha R, Tappero JW, Trirat N, Muktier S, Chancharastong P, Fox K, Donchalermpak S, Vitek C, Supawitkul S. Prevalence of hepatitis B, tetanus, hepatitis A, human immunodeficiency virus and feasibility of vaccine delivery among injecting drug users in Bangkok, Thailand, 2003-2005. Addiction 2008; 103:1687-95. [PMID: 18705685 DOI: 10.1111/j.1360-0443.2008.02303.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To estimate the prevalence of hepatitis B virus (HBV), tetanus, hepatitis A virus (HAV) and human immunodeficiency virus (HIV) in injecting drug users (IDUs), risk factors associated with infection and the feasibility of HBV vaccine delivery in HBV seronegatives. METHODS Cross-sectional seroprevalence survey of 1535 IDUs recruited from 17 Bangkok Metropolitan Administration (BMA) methadone clinics and HBV vaccination of seronegatives. RESULTS Prevalence of antibody to HBV, tetanus, HAV and HIV was 87.8%, 68.1%, 60.2% and 35.9%, respectively. Prevalence of HBV and HAV increased with increasing age; prevalence of tetanus decreased with increasing age. Being HIV seropositive was related inversely to income and being tetanus seronegative. Of the 189 HBV seronegative IDUs, 81.0% completed the vaccine series. IDUs with HIV had a 6.5-fold odds of vaccine non-response. CONCLUSIONS These data underscore the need for, and feasibility of, vaccine delivery in this population and support targeting efforts at high-risk age groups.
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13
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Kresina TF, Sylvestre D, Seeff L, Litwin AH, Hoffman K, Lubran R, Clark HW. Hepatitis infection in the treatment of opioid dependence and abuse. Subst Abuse 2008; 1:15-61. [PMID: 25977607 PMCID: PMC4395041 DOI: 10.4137/sart.s580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Many new and existing cases of viral hepatitis infections are related to injection drug use. Transmission of these infections can result directly from the use of injection equipment that is contaminated with blood containing the hepatitis B or C virus or through sexual contact with an infected individual. In the latter case, drug use can indirectly contribute to hepatitis transmission through the dis-inhibited at-risk behavior, that is, unprotected sex with an infected partner. Individuals who inject drugs are at-risk for infection from different hepatitis viruses, hepatitis A, B, or C. Those with chronic hepatitis B virus infection also face additional risk should they become co-infected with hepatitis D virus. Protection from the transmission of hepatitis viruses A and B is best achieved by vaccination. For those with a history of or who currently inject drugs, the medical management of viral hepatitis infection comprising screening, testing, counseling and providing care and treatment is evolving. Components of the medical management of hepatitis infection, for persons considering, initiating, or receiving pharmacologic therapy for opioid addiction include: testing for hepatitis B and C infections; education and counseling regarding at-risk behavior and hepatitis transmission, acute and chronic hepatitis infection, liver disease and its care and treatment; vaccination against hepatitis A and B infection; and integrative primary care as part of the comprehensive treatment approach for recovery from opioid abuse and dependence. In addition, participation in a peer support group as part of integrated medical care enhances treatment outcomes. Liver disease is highly prevalent in patient populations seeking recovery from opioid addiction or who are currently receiving pharmacotherapy for opioid addiction. Pharmacotherapy for opioid addiction is not a contraindication to evaluation, care, or treatment of liver disease due to hepatitis virus infection. Successful pharmacotherapy for opioid addiction stabilizes patients and improves patient compliance to care and treatment regimens as well as promotes good patient outcomes. Implementation and integration of effective hepatitis prevention programs, care programs, and treatment regimens in concert with the pharmacological therapy of opioid addiction can reduce the public health burdens of hepatitis and injection drug use.
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Affiliation(s)
- Thomas F Kresina
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD
| | - Diana Sylvestre
- Department of Medicine, University of California, San Francisco and Organization to Achieve Solutions In Substance Abuse (O.A.S.I.S.) Oakland, CA
| | - Leonard Seeff
- Division of Digestive Diseases and Nutrition, National Institute on Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, DHHS, Bethesda, MD
| | - Alain H Litwin
- Division of Substance Abuse, Albert Einstein College of Medicine, Montefiore Medical Center Bronx, NY
| | - Kenneth Hoffman
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD
| | - Robert Lubran
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD
| | - H Westley Clark
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD
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Bart G, Piccolo P, Zhang L, Jacobson I, Schaefer RA, Kreek MJ. Markers for hepatitis A, B and C in methadone maintained patients: an unexpectedly high co-infection with silent hepatitis B. Addiction 2008; 103:681-6. [PMID: 18339114 PMCID: PMC3810150 DOI: 10.1111/j.1360-0443.2008.02151.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIMS To determine the prevalence of hepatitis A, B and C viruses in patients attending a methadone maintenance clinic in New York City. DESIGN Cross-sectional. SETTING The Adult Services Clinic of Weill Cornell Medical College, an urban hospital-affiliated methadone program. PARTICIPANTS Former heroin addicted adults (n = 103) on methadone maintenance therapy. MEASUREMENTS Markers for hepatitis A virus [HAV immunoglobulin M (IgM) and imunoglobulin G (IgG)], hepatitis B [hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb) and hepatitis B core antibody (HBcAb)] and hepatitis C virus (HCVAb). Serum alanine aminotransferase (ALT) and quantitative HCV RNA were also obtained. Qualitative detection of HBV DNA and HCV genotype were obtained in a subset of subjects. FINDINGS More than 40% of subjects had markers for all three viruses. HCVAb was the most prevalent (83.5%), followed by HBcAb (65.0%), HAV IgG (46.1%) and HBsAb (41.1%). Hepatitis C RNA was detected in 70.6% of HCVAb positive subjects. While no subject had HBsAg, HBV DNA was detected in 26.4% of subjects who underwent this measure; all (n = 20) had HBcAb as their only HBV marker. The presence of HBV DNA did not influence ALT. Subjects with HCV RNA had higher ALTs than those without HCV RNA. CONCLUSIONS Most methadone-maintained subjects had at least one marker for viral hepatitis, with 41.8% having markers for HAV, HBV and HCV. A quarter of subjects had silent HBV infection, defined as the presence of HBV DNA in the absence of HBsAg. These subjects should be considered infectious and pose a public health risk.
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Affiliation(s)
- Gavin Bart
- The Laboratory of the Biology of Addictive Diseases, The Rockefeller University, NY, NY 10021, USA.
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15
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Koya DL, Hill EG, Darden PM. The effect of vaccinated children on increased hepatitis B immunization among high-risk adults. Am J Public Health 2008; 98:832-8. [PMID: 18382000 DOI: 10.2105/ajph.2007.116046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to examine trends in hepatitis B virus (HBV) vaccination among high-risk adults and assess the potential effect vaccinated adolescents have on these trends as they age. METHODS We used data from the National Health Interview Survey 2000, 2002, and 2004 to examine trends in HBV vaccination among high-risk adults aged 18 to 49 years and in age subgroups (18-29, 30-39, and 40-49 years). We investigated temporal differences in vaccination rates for the 18- to 29-year-old cohort with model-based linear contrasts constructed from a logistic regression model with age and survey year as predictors. RESULTS There was a significant increasing trend in vaccination prevalence across the 3 survey years (32.6%, 35.3%, and 41.4%; trend test, P=.001). We found that respondents aged 18 to 29 years were more likely to be vaccinated in 2004 than in 2000, after adjusting for relevant confounders (odds ratio=1.73; 95% confidence interval=1.14, 2.6); there was no significant increase in vaccination for the other cohorts. CONCLUSIONS A cohort effect, in which successfully vaccinated adolescents have reached young adulthood, contributes significantly to recent trends showing improved HBV vaccination among high-risk adults.
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Affiliation(s)
- Deepika L Koya
- Health Services Research/Academic Generalist Fellowship Program and the Department of Internal Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
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16
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Amesty S, Ompad DC, Galea S, Fuller CM, Wu Y, Koblin B, Vlahov D. Prevalence and Correlates of Previous Hepatitis B Vaccination and Infection Among Young Drug-users In New York City. J Community Health 2008; 33:139-48. [DOI: 10.1007/s10900-007-9082-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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17
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Campbell JV, Garfein RS, Thiede H, Hagan H, Ouellet LJ, Golub ET, Hudson SM, Ompad DC, Weinbaum C. Convenience is the key to hepatitis A and B vaccination uptake among young adult injection drug users. Drug Alcohol Depend 2007; 91 Suppl 1:S64-72. [PMID: 17276018 DOI: 10.1016/j.drugalcdep.2006.09.022] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Revised: 09/16/2006] [Accepted: 09/17/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND Despite CDC recommendations to vaccinate injection drug users (IDUs) against hepatitis A virus (HAV) and hepatitis B virus (HBV) infections, coverage remains low. Vaccination programs convenient to IDUs have not been widely implemented or evaluated. We assessed whether convenience and monetary incentives influenced uptake of free vaccine by 18-30-year-old IDUs in five U.S. cities. METHODS IDUs recruited from community settings completed risk behavior self-interviews and testing for antibodies to HAV (anti-HAV) and hepatitis B core antigen (anti-HBc). Vaccine was offered presumptively at pre-test (except in Chicago); on-site availability and incentives for vaccination differed by site, creating a quasi-experimental design. RESULTS Of 3181 participants, anti-HAV and anti-HBc seroprevalence was 19% and 23%, respectively. Although 83% of participants were willing to be vaccinated, only 36% received > or =1 dose, which varied by site: Baltimore (83%), Seattle (33%), Los Angeles (18%), New York (17%), and Chicago (2%). Participation was highest when vaccine was available immediately on-site and lowest when offered only after receiving results. Monetary incentives may have increased participation when on-site vaccination was not available. CONCLUSION IDUs were willing to be vaccinated but immediate, on-site availability was critical for uptake. Convenience should be a key consideration in designing strategies to increase vaccine coverage among IDUs.
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Affiliation(s)
- Jennifer V Campbell
- HIV/AIDS Epidemiology Program, Public Health-Seattle & King County, 400 Yesler Way 3rd Floor, c/o Hanne Thiede, Seattle, WA 98104, USA.
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18
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Baral S, Sherman SG, Millson P, Beyrer C. Vaccine immunogenicity in injecting drug users: a systematic review. THE LANCET. INFECTIOUS DISEASES 2007; 7:667-74. [PMID: 17897609 DOI: 10.1016/s1473-3099(07)70237-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Injection drug use is a prevalent global phenomenon; one not bound by a country's level of development or geographical location. Injection drug users (IDUs) are at high risk for a variety of parenterally acquired and transmitted infections. Licensed vaccines are available for some of these infectious diseases, such as tetanus, influenza, and hepatitis A and B viruses; however, there have been conflicting reports as to their immunogenicity in IDUs. We summarise the lessons learned from studies evaluating the immunogenicity of vaccination strategies in IDUs. A common theme across these diseases is that although there is a tendency towards decreased antibody responses after immunisation, there is no conclusive evidence linking these observations to a decrease in clinical protection from infection. There is a clear need for definitive studies of vaccination strategies in IDUs; however, a synthesis of the available published evidence suggests that immunisation does result in effective clinical protection from disease in this population. The inclusion of IDUs as a high-risk study population in future trials evaluating HIV and hepatitis C virus vaccines will help to assess the immunogenicity of candidate vaccines against parenteral exposure, and also to evaluate the efficacy of candidates as promising antigens become available.
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Affiliation(s)
- Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD 21205, USA.
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19
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Brim N, Zaller N, Taylor LE, Feller E. Twinrix®vaccination schedules among injecting drug users. Expert Opin Biol Ther 2007; 7:379-89. [PMID: 17309329 DOI: 10.1517/14712598.7.3.379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Twinrix is the only licensed vaccine that provides dual protection against infection with hepatitis A virus (HAV) and hepatitis B virus (HBV). The standard vaccination schedule for Twinrix is 0, 1 and 6 months. However, many high-risk populations, such as injecting drug users (IDUs), do not complete the vaccination series and, thus, do not acquire sufficient immunity against HAV and HBV. Twinrix can be administered using an accelerated vaccination schedule of 0, 7 and 21 days, with a booster recommended at 12 months. This manuscript reviews the available literature on vaccinating IDUs against HAV and HBV. The authors conclude that there is insufficient evidence regarding whether the accelerated Twinrix HAV/HBV vaccination schedule would yield a greater number of IDUs protected against both HAV and HBV.
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Affiliation(s)
- Nancy Brim
- Brown Medical School, Providence, Rhode Island, USA, 2The Miriam Hospital, 164 Summit Ave, Providence, RI 02906, USA.
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20
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Edlin BR, Kresina TF, Raymond DB, Carden MR, Gourevitch MN, Rich JD, Cheever LW, Cargill VA. Overcoming barriers to prevention, care, and treatment of hepatitis C in illicit drug users. Clin Infect Dis 2006; 40 Suppl 5:S276-85. [PMID: 15768335 PMCID: PMC1510897 DOI: 10.1086/427441] [Citation(s) in RCA: 168] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Injection drug use accounts for most of the incident infections with hepatitis C virus (HCV) in the United States and other developed countries. HCV infection is a complex and challenging medical condition in injection drug users (IDUs). Elements of care for hepatitis C in illicit drug users include prevention counseling and education; screening for transmission risk behavior; testing for HCV and human immunodeficiency virus infection; vaccination against hepatitis A and B viruses; evaluation for comorbidities; coordination of substance-abuse treatment services, psychiatric care, and social support; evaluation of liver disease; and interferon-based treatment for HCV infection. Caring for patients who use illicit drugs presents challenges to the health-care team that require patience, experience, and an understanding of the dynamics of substance use and addiction. Nonetheless, programs are successfully integrating hepatitis C care for IDUs into health-care settings, including primary care, methadone treatment and other substance-abuse treatment programs, infectious disease clinics, and clinics in correctional facilities.
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Affiliation(s)
- Brian R. Edlin
- Center for the Study of Hepatitis C, Weill Medical College of Cornell University, New York
| | - Thomas F. Kresina
- Center on AIDS and Other Medical Consequences of Drug Abuse, National Institute on Drug Abuse, Bethesda, Maryland
| | | | - Michael R. Carden
- Center for the Study of Hepatitis C, Weill Medical College of Cornell University, New York
| | - Marc N. Gourevitch
- Division of General Internal Medicine, New York University School of Medicine, New York
| | - Josiah D. Rich
- Miriam Hospital, Brown University School of Medicine, Providence, Rhode Island
| | - Laura W. Cheever
- HIV/AIDS Bureau, Health Resources and Services Administration, Department of Health and Human Services, Washington, DC
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21
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Abstract
Co-infection of HIV-positive patients with hepatitis viruses worsens the long-term prognosis and this is summative for each new infection in any individual. Vaccination against hepatitis A or B may be effective but response rates are reduced in HIV infected patients. Improvement in response can be induced through extra doses, higher doses and HAART-induced increase in the CD4 count. Hepatitis B and C may also be prevented through counselling about safer sex, particularly condom use. In intravenous drug users, harm reduction, counselling and the use of needle/syringe exchange schemes may be helpful.
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Affiliation(s)
- Gary Brook
- Patrick Clements Clinic, Central Middlesex Hospital, Acton Lane, London NW10 7NS, UK.
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22
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Abstract
Injection drug users (IDUs) are at high risk for hepatitis B virus (HBV); however, they often do not receive preventive vaccination. IDUs who use mobile health care services linked to a syringe exchange program in New Haven were routinely screened for HBV, hepatitis C virus, and syphilis. Individuals without prior exposure to HBV were offered three-part vaccination series. Of the 212 IDUs screened for HBV infection, 134 (63%) were eligible (negative for HBV surface and core anti-bodies) for vaccination and 10 (4.7%) had evidence of chronic HBV infection. Compared to those with previous exposure to HBV, vaccine-eligible patients were significantly more likely to be younger and use heroin and less likely to be black, home-less, daily injectors, and cocaine users. Of the 134 vaccine-eligible subjects, 103 (77%) and 89 (66%) completed two and three vaccinations, respectively. Correlates of completing all three vaccinations included older age (OR = 1.06, 95% CI = 1.04-1.07), injecting daily (OR = 2.12, 95% CI = 1.36-6.73), and being homeless (OR = 1.98, 95% CI = 1.14-12.27). These results suggest that IDUs remain at high risk for acquiring HBV infection. Programs that link health care to a syringe exchange program are effective ways to provide preventive health care services to IDUs, particularly HBV vaccination. Trust engendered by and mutual respect afforded by such programs result in repeated encounters by active IDUs over time.
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Affiliation(s)
- Frederick L Altice
- Yale University AIDS Program, 135 College Street, Suite 323, New Haven, CT 06510-2283, USA.
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23
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Kuo I, Sherman SG, Thomas DL, Strathdee SA. Hepatitis B virus infection and vaccination among young injection and non-injection drug users: missed opportunities to prevent infection. Drug Alcohol Depend 2004; 73:69-78. [PMID: 14687961 DOI: 10.1016/j.drugalcdep.2003.10.007] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We examined correlates of HBV infection and vaccination and the missed vaccination opportunities among young injection drug users (IDUs) and non-injection drug users (NIDUs). METHODS Two hundred IDUs and 124 NIDUs aged 15-30 years were studied. Demographics, drug use and sexual behaviors, and health and incarceration history data were collected. Serology was conducted for antibodies to HBV-core antigen (anti-HBc) and HBV-surface antigen (anti-HBs). Presence of anti-HBc indicated past HBV infection; presence of anti-HBs alone indicated past vaccination. RESULTS More IDUs had been infected with HBV in the past than NIDUs (37% versus 19%, P = 0.001). Among male and female IDUs, injection drug use behaviors were significantly associated with past infection. For female IDUs, being African-American and trading sex were also associated with previous infection. Among NIDUs, being female and longer time since sexual debut were associated with past infection. Overall, 11% were vaccinated (10% IDU versus 14% NIDU, P = 0.30). Younger age and drug treatment history were associated with vaccination. Most susceptibles (84%) experienced at least one missed opportunity for vaccination. CONCLUSION Young drug users remain at high risk for HBV infection. Vaccination rates remain low despite multiple opportunities for vaccination. An integrated HBV immunization effort should be coordinated among venues frequented by young drug users.
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Affiliation(s)
- Irene Kuo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, E6006 Baltimore, MD 21205, USA
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24
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Lum PJ, Ochoa KC, Hahn JA, Page Shafer K, Evans JL, Moss AR. Hepatitis B virus immunization among young injection drug users in San Francisco, Calif: the UFO Study. Am J Public Health 2003; 93:919-23. [PMID: 12773355 PMCID: PMC1447870 DOI: 10.2105/ajph.93.6.919] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Paula J Lum
- Positive Health Program, Department of Medicine, University of California, San Francisco 94143-0874, USA.
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25
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Rich JD, Ching CG, Lally MA, Gaitanis MM, Schwartzapfel B, Charuvastra A, Beckwith CG, Flanigan TP. A review of the case for hepatitis B vaccination of high-risk adults. Am J Med 2003; 114:316-8. [PMID: 12681460 DOI: 10.1016/s0002-9343(02)01560-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The sequelae of hepatitis B virus infection include fulminant liver failure, chronic liver disease, hepatocellular carcinoma, and death. The hepatitis B vaccine is efficacious, safe, and cost-effective, but has been consistently underutilized in high-risk adults despite long-standing recommendations. Instituting routine hepatitis B vaccination for high-risk adults in settings such as prisons and jails, sexually transmitted disease clinics, drug treatment centers, and needle exchange programs could prevent up to 800 cases of hepatitis, and 10 deaths from hepatitis, per 10,000 vaccinations, with an overall cost savings. Low rates of completion of the three-dose series and lack of funding for adult immunizations have always been challenges to offering hepatitis B vaccines to high-risk adults. However, there is benefit to an incomplete vaccination series, and high-risk populations are accessible for follow-up vaccination outside of traditional medical settings. A clear national objective and federal funding for vaccinating high-risk adults are needed.
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Affiliation(s)
- Josiah D Rich
- The Miriam Hospital/Brown University School of Medicine, 164 Summit Avenue, Providence, RI 02906, USA.
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26
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Piccolo P, Borg L, Lin A, Melia D, Ho A, Kreek MJ. Hepatitis C Virus and Human Immunodeficiency Virus-1 Co-Infection in Former Heroin Addicts in Methadone Maintenance Treatment. J Addict Dis 2002; 21:55-66. [PMID: 12296502 DOI: 10.1300/j069v21n04_06] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To investigate hepatitis C (HCV) and human immunodeficiency virus (HIV-1) prevalence in former opiate or heroin addicts currently in methadone maintenance treatment (MMT). METHODS Retrospective chart review for patients (n = 342) currently attending two MMT clinics affiliated with New York Presbyterian Hospital (Adolescent Development Program, ADP: n = 106, median age 30 years; Adult Clinic, AC: n = 236, median age 45 years), as of May 2000. RESULTS Overall seroprevalence of those tested was 67% for HCV (ADP, 44%; AC, 80%), and 29% for HIV-1 (ADP, 13%, AC, 39%). Co-infection was present in 26% of patients (ADP, 13%; AC, 35%). Prevalence of HCV reached 92% in the 45-49 year old group (n = 53). The greatest HIV-1 prevalence (45%) was in the 35-39 year old group (n = 33). There was a linear relationship between infection seroprevalence and age at admission into MMT. CONCLUSIONS The high prevalence of HCV and HIV-1 infections in MMT patients varies both by current age and by age at admission to MMT. This population needs risk reduction education and treatment for HCV and HIV- 1.
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Affiliation(s)
- Paola Piccolo
- Laboratory of the Biology of Addictive Diseases, The Rockefeller University, New York, NY 10021, USA.
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27
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Kreek MJ, Vocci FJ. History and current status of opioid maintenance treatments: blending conference session. J Subst Abuse Treat 2002; 23:93-105. [PMID: 12220607 DOI: 10.1016/s0740-5472(02)00259-3] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Opiate addiction is a chronic, relapsing disorder. Left untreated, high morbidity and mortality rates are seen. Pharmacotherapies for this disorder using mu opiate agonists (methadone and levomethadyl acetate) and partial agonists have been developed in the last 40 years. Agonist pharmacotherapy with oral methadone for the treatment of opiate dependence was developed in clinical pharmacology studies at Rockefeller University by Dole, Nyswander, and Kreek. Further studies by this laboratory and others established that moderate to high dose treatment with methadone (80-120 mg) reduced or eliminated opiate use in outpatient settings with consequent reductions in morbidity and up to 4-fold reductions in mortality. Levomethadyl acetate (LAAM), a congener of methadone, is biotransformed to active metabolites responsible for its longer duration of action. The Federal Regulations regarding the dispensation of methadone and LAAM have recently been revised to facilitate the treatment of patients under a "medical maintenance" model. Future regulatory reform will likely involve the establishment of rules for "office based opioid treatment."
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Affiliation(s)
- Mary Jeanne Kreek
- The Laboratory of the Biology of Addictive Diseases, The Rockefeller University and The Rockefeller University Hospital, New York, NY 10021, USA
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Quaglio G, Talamini G, Lugoboni F, Lechi A, Venturini L, Jarlais DCD, Mezzelani P. Compliance with hepatitis B vaccination in 1175 heroin users and risk factors associated with lack of vaccine response. Addiction 2002; 97:985-92. [PMID: 12144601 DOI: 10.1046/j.1360-0443.2002.00147.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS To investigate the feasibility of hepatitis B vaccination among heroin users, assessing adherence to the vaccination schedules and identifying factors associated with antibody response. DESIGN AND PARTICIPANTS A large cohort study in nine public centres for drug users (PCDUs) in north-eastern Italy, with data collected between January 1989 and December 1998. A total of 1175 heroin users were selected and vaccinated with a recombinant vaccine using two schedules (0-1-6 months and 0-1-2 months). FINDINGS Eighty-eight per cent of patients completed the vaccination series and a protective antibody response occurred in 77% of subjects. Completion of the vaccination series was not related to the length of the vaccination schedule or whether the patient was still in drug abuse treatment at the end of the series, but was related strongly to the number of patients enrolled at each PCDU (Spearman correlation = - 0.93, P < 0.001). Four variables were significantly associated with lack of seroconversion in response to vaccination: older age (AOR = 0.91 per year, 95% CI 0.88-0.94, P < 0.001), 2-month vaccination schedule (AOR = 3.10, 95% CI 2.06-4.68, P < 0.001), HCV seropositivity (AOR = 0.69, 95% CI 0.47-0.99, P = 0.04), HIV seropositivity (AOR = 0.27, 95% CI 0.10-0.77, P = 0.01). CONCLUSIONS A large-scale, multi-site hepatitis B vaccination programme for heroin users proved feasible and effective. The factors associated with a lack of antibody response may be useful in identifying patients who would benefit most from routine post-vaccination testing, with booster doses for non-responders. These results suggest that hepatitis B vaccination for drug users should become a routine public health practice.
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Affiliation(s)
- Gianluca Quaglio
- Medical Service for Addictive Disorders, Department of Internal Medicine, University of Verona, Italy
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29
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Awofeso N, Levy M, Harper S, Jones M, Hayes M, Douglas J, Fisher M, Folpp D. Response to HBV vaccine in relation to vaccine dose and anti-HCV positivity: a New South Wales correctional facilities' study. Vaccine 2001; 19:4245-8. [PMID: 11457551 DOI: 10.1016/s0264-410x(01)00172-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Currently, about two-thirds of inmates in NSW correctional facilities have a history of injection drug use, and about half have serological evidence of exposure to hepatitis C virus. The introduction of an accelerated hepatitis B vaccination program (0-1-2 months) in 1998, using a 20 microg/dose vaccine was necessitated by the need to vaccinate eligible inmates in this high-risk environment characterised by rapid client mobility. Since 1999, both 10 and 20 microg doses of vaccine were introduced. We found that sero-response rates were not significantly influenced by HCV antibody status, but were significantly lower in cohorts of inmates vaccinated with the 10 microg dose of vaccine.
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Affiliation(s)
- N Awofeso
- New South Wales Corrections Health Service, P.O. Box 150, NSW 2036, Matraville, Australia.
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Pollack HA. Can we protect drug users from hepatitis C? JOURNAL OF POLICY ANALYSIS AND MANAGEMENT : [THE JOURNAL OF THE ASSOCIATION FOR PUBLIC POLICY ANALYSIS AND MANAGEMENT] 2001; 20:358-364. [PMID: 12693416 DOI: 10.1002/pam.2114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- H A Pollack
- University of Michigan School of Public Health, Ann Arbor, USA
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Kreek MJ. Methadone-related opioid agonist pharmacotherapy for heroin addiction. History, recent molecular and neurochemical research and future in mainstream medicine. Ann N Y Acad Sci 2000; 909:186-216. [PMID: 10911931 DOI: 10.1111/j.1749-6632.2000.tb06683.x] [Citation(s) in RCA: 186] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In 1963, Professor Vincent P. Dole at the Rockefeller University formed a small team to develop a pharmacotherapy for the management of heroin addiction. They hypothesized that heroin addiction is a disease of the brain with behavioral manifestations, and not merely a personality disorder or criminal behavior and began to address the specific question of whether a long-acting opioid agonist could be used in the long-term maintenance treatment of heroin addiction. Over the next 35 years, many studies documented the safety, efficacy and effectiveness of methadone pharmacotherapy for heroin addiction, but Federal regulations and stigmatization of heroin addiction prevented implementation of treatment. Finally, in 1999, NIH published a report unequivocally supporting methadone maintenance pharmacotherapy for heroin addiction. Two other effective opioid agonist treatments have been developed: the even longer acting opioid agonist l-alpha-acetylmethadol (LAAM) has been approved for pharmacotherapy for heroin addiction, and still under study is the opioid partial agonist-antagonist buprenorphine-naloxone combination. A variety of studies, both laboratory based and clinical, have revealed the mechanisms of action of long-acting opioid agonists in treatment, including prevention of disruption of molecular, cellular and physiologic events and, in fact, allowing normalization of those functions disrupted by chronic heroin use. Recent molecular biological studies have revealed single nucleotide polymorphisms of the human mu opioid receptor gene; the mu opioid receptor is the site of action of heroin, the major opiate drug of abuse, analgesic agents such as morphine, and the major treatment agents for heroin addiction. These findings support the early hypotheses of our laboratory that addiction may be due to a combination of genetic, drug-induced and environmental (including behavioral) factors and also, that atypical stress responsivity may contribute to the acquisition and persistence of, as well as relapse to, use of addictive drugs.
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Affiliation(s)
- M J Kreek
- Laboratory of the Biology of Addictive Diseases, Rockefeller University, New York, New York 10021, USA.
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