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In-Brief: January 18th, 2018

In Brief is NEAETC's news service covering the latest developments and educational resources about HIV, hepatitis, health disparities, and related topics. To subscribe, please click HERE.

HIV, Hepatitis, and the Opioid Epidemic

NBHS Finds Reduced HIV Prevalence Among Persons Who Inject Drugs

A new report from the National HIV Behavioral Surveillance (NHBS) study, which focused on persons living with HIV who inject drugs (PWID), found that the prevalence of HIV infection among PWID was 7% in 2015, a substantial decline from the 11% HIV prevalence reported in the previous NHBS survey of PWID conducted in 2012. CDC’s NHBS conducts interviews and HIV testing in selected metropolitan statistical areas (MSAs) across the U.S.  The 2015 survey included data on PWID in 20 MSAs.  Among HIV-negative NHBS respondents, 27% reported sharing syringes and 67% reported having vaginal sex without a condom during the previous 12 months.  Only 52% received syringes from a syringe services program, and 34% received all syringes from sterile sources.  HIV infection prevalence in the PWID surveyed was higher among Blacks (11%) than Whites (6%). However, in the previous 12 months, a substantially greater proportion of White PWID shared syringes compared to Blacks (39% versus 17%) and injection equipment (61% versus 41%).

In comments on the implications of the study, CDC researchers concluded, “Access to sterile injection and drug preparation equipment is critical for the prevention of HIV infections among persons who inject drugs.  Although access to syringes through syringe services programs has increased in the United States, the available supply is likely insufficient to meet the demand, and multiple areas continue to lack access to these services.  The recent opioid use epidemic increases the potential for HIV outbreaks among persons who inject drugs, particularly in areas with limited prevention services for persons who inject drugs.  Thus, failure to respond appropriately to this prevention gap could reverse earlier successes in reducing HIV infection among persons who inject drugs.  Comprehensive syringe services programs reduce transmission of HIV and other infections by providing access to safe syringe disposal; risk reduction education; HIV and viral hepatitis testing; referrals to health services including treatment for HIV, HCV, or substance use disorder (including medication-assisted therapy) and mental health disorders; and pre-exposure prophylaxis.  Recent changes in federal appropriations law permitting the use of federal funding to support syringe services programs present an opportunity to improve access to these critical prevention services to persons who inject drugs.”

February AJPF Issue Focuses on Linked Epidemics of Opioid Addiction and HCV

The February 2018 issue of the American Journal of Public Health features articles and editorials about the linked epidemics of opioid addiction and infection with hepatitis C virus (HCV). Relevant content includes:

•            Facing Addiction: A Laudable, But Incomplete Effort (book review)

•            Opioids, Hepatitis C Virus Infection, and the Missing Vaccine (editorial)

•            How Should the Epidemiology of Acute Hepatitis C and Opioid Use Affect Health Policy Decision-Making? (policy)

•            Increases in Acute Hepatitis C Virus Infection Related to a Growing Opioid Epidemic and Associated Injection Drug Use, United States, 2004 to 2014 (epidemiology)

•            Opioid Crisis: No Easy Fix to Its Social and Economic Determinants (perspective)

One of the AJPH studies reported dramatic simultaneous increases in acute HCV across the U.S. (133%) and admissions for opioid injection (93%) during the period from 2004 through 2014.  Rates of opioid injection – especially injection of prescription opioid pain relievers, as well as heroin – and acute hepatitis C virus infections increased most dramatically from 2004 to 2014 among younger Americans (ages 18 to 39).

Among 18- to 29-year-olds, there was a:

•            400% increase in acute hepatitis C;

•            817% increase in admissions for injection of prescription opioids; and

•            600% increase in admissions for heroin injection.

Among 30- to 39-year-olds, there was a:

•            325% increase in acute hepatitis C;

•            169% increase in admissions for injection of prescription opioids; and

•            77% increase in admissions for heroin injection.

According to CDC, “The new findings underscore the need for comprehensive community opioid prevention services programs that:

•            support drug treatment and recovery services, including medication-assisted treatment, which can help people who inject drugs stop injecting – the primary risk behavior leading to new hepatitis C virus infection; and

•            provide a range of testing, treatment and prevention services for hepatitis C and other infectious diseases, including hepatitis B and HIV.”

HIV Year in Review: 2017

An Additional Take on the Top HIV Developments of 2017

In the last issue of In Brief, we summarized several recent articles listing HIV clinicians’ and writers’ choices for the most significant HIV stories of 2017.  Late last month, the website HIVandHepatitis.com published another perspective on the top HIV and hepatitis news of last year.  For your easy review, we have listed their choices for the top ten developments below.  The article provides a one-paragraph summary of each development, together with links to related articles that provide more extensive detail.

•            Convergence of HIV Cure and Cancer Research

•            Undetectable = Untransmittable

•            Dual-Drug HIV Treatment and Other New Therapies

•            HIV Infections Fall – But Not for Everyone

•            Trans People and HIV

•            New Hepatitis C Approvals – and the End of Drug Development?

•            Can Hepatitis C Be Eliminated?

•            Hepatitis C Treatment and Liver Cancer

•            Progress on Hepatitis B

•            Fatty Liver Disease a Growing Challenge

HIV-Related Guidelines

New York’s AIDS Institute Releases Comprehensive Update to Cervical Cancer Screening Guideline

The New York State Department of Health’s AIDS Institute has just released a comprehensive update to its clinical practice guideline, Cervical Screening for Dysplasia and Cancer in the Setting of HIV Infection. The revised guidelines include the following new recommendations:

•            Clinicians should offer all individuals with HIV infection aged 9 to 26 years the 9-valent human papillomavirus (HPV) vaccine 3-dose series regardless of their prior Pap test results or their CD4 cell count.

•            Clinicians should perform a cervical Pap test for all females who have HIV infection at the following time intervals: 1) within 2 years of the onset of sexual activity or by age 21 years; 2) annually until 2 tests in a row screen negative, then every 3 years; 3) at 6 months after treatment for an abnormal result, then annually until 2 tests in a row screen negative, then every 3 years; and 4) after total hysterectomy (uterus and cervix removed), clinicians should perform vaginal Pap testing at least annually until results are negative for 2 tests in a row, then every 3 years.

•            Clinicians should perform HPV co-testing only for females who are more than 30 years old.

The New York guideline also contains new sections concerning the prevention of cervical cancer and precancerous lesions and the recommended follow-up for abnormal Pap test results.  In addition, the guidelines emphasize that patients with HIV infection who are newly diagnosed with cervical cancer should be immediately referred to a gynecologic oncologist or surgeon trained in the management of cervical malignancies.

Educational Tools

University of Washington Launches National STD Curriculum

The University of Washington’s STD Prevention Training Center (SPTC) plans to launch its new National STD Curriculum in a webinar on January 25. The curriculum has seven self-study modules on the following major sexually transmitted diseases and related conditions: chlamydia, gonorrhea, herpes simplex virus, human papillomavirus, pelvic inflammatory disease, syphilis, and vaginitis.  The modules are based on the most recent CDC STD Treatment Guidelines and address the epidemiology, pathogenesis, clinical manifestations, diagnosis, management, and prevention – plus key points to remember – for each of the seven STDs and related conditions listed above. The curriculum also features 12 “Question Bank” topics with more than 100 interactive board-review style questions.  The curriculum's target audience is medical providers, including physicians, physician assistants, nurse practitioners, nurses, and nurse-midwives.  One hour of free Continuing Medical Education (CME) credit is available upon successful completion of each of the seven modules.  The STD curriculum was funded by a grant from the CDC.

Health Communication and Social Media

New HIV.gov Posts Focusing on Digital Health Communication

As described in previous In Brief issues, the HIV.gov blog continues to post resources and tips to help readers enhance their digital communication strategies.  During the past month, HIV.gov has posted the following features on digital communication:

•Digital Strategy Tips from Government Social Media Managers

•New Year’s Resolutions for Digital Communicators

•The Top 17 Digital Tools Blog Posts of 2017

•Digital and Social Media Trends to Watch in 2018

•Oh Snap! Everything You Need to Know About Using Snapchat for HIV

Other New and Updated Resources

New and Updated HIV Materials from AIDSinfo and CDC

The AIDSinfo website recently posted several updated fact sheets on HIV-related topics. Each fact sheet includes a summary of key points, together with links to additional information and resources. The fact sheets are available in both English and Spanish.

•How to Find HIV Treatment Services (Spanish version)

•HIV and Mental Health (Spanish version)

•HIV and Nutrition and Food Safety (Spanish version)

CDC has also produced several new HIV-related resources:

•HIV in the United States by Geography (fact sheet)

•HIV in the United States: At a Glance (fact sheet)

•HIV Surveillance – Adolescents and Young Adults (slide set)