Psychiatric and substance use disorders comorbidities in veterans with hepatitis C virus and HIV coinfection

ArticleinCurrent opinion in Psychiatry 22(4):401-8 · June 2009with6 Reads
DOI: 10.1097/YCO.0b013e32832cadb9 · Source: PubMed
Abstract
A growing number of veterans in the Veterans Health Administration are coinfected with HIV and hepatitis C virus. This review covers timely research relative to comorbid conditions that are common in this population including psychiatric diagnoses, substance use disorders and neurocognitive problems. Current literature on the psychiatric, substance use disorders and cognitive problems of the coinfected population show that not only are rates of morbidity higher in the coinfected population but that this affects antiviral treatments as well. There is new evidence that brain injuries and infiltration of the virus into the central nervous system may be responsible for cognitive dysfunction. Cotesting, particularly in hepatitis C infected individuals, is not done routinely despite shared risk factors. With this understanding of the comorbidities of the coinfected population, integrated healthcare models involving mental health, internal medicine, substance abuse treatment and internal medicine are crucial to work with these medically and psychologically complex patients.
    • "Therefore, despite inclusion of these persons in the analysis, the viral burden of the overall clinic population markedly decreased over the 13 years of this evaluation. These gains are particularly meaningful given patients' significant barriers to success34567891011121314151617. In our clinic, more than half of our veterans have major medical, mental health or substance abuse issues. "
    [Show abstract] [Hide abstract] ABSTRACT: HIV-1 RNA and CD4 cell counts are important parameters for HIV care. The objective of this study was to assess the overall trends in HIV-1 viral load and CD4 cell counts within our clinic. Patients with at least one of each test performed by the Infectious Diseases Laboratory from 1999 through 2011 were included in this analysis. By adapting a novel statistical model, log(10) HIV-1 RNA means were estimated by month, and log(10)-transformed HIV-1 RNA means were estimated by calendar year. Geometric means were calculated for CD4 cell counts by month and calendar year. Log(10) HIV-1 RNA and CD4 cell count monthly means were also examined with polynomial regression. There were 1,814 individuals with approximately 25,000 paired tests over the 13-year observation period. Based on each patient's final value of the year, the percentage of patients with viral loads below the lower limit of quantitation rose from 29% in 1999 to 72% in 2011, while the percentage with CD4 counts <200 cells/µL fell from 31% to 11%. On average annually, the mean HIV-1 RNA decreased by 86 copies/mL and the mean CD4 counts increased by 16 cells/µL. For the monthly means, the correlations (R(2)) from second-order polynomial regressions were 0.944 for log(10) HIV-1 RNA and 0.840 for CD4 cell counts. Marked improvements in HIV-1 RNA suppression and CD4 cell counts were achieved in a large inner-city population from 1999 through 2011. This success demonstrates that sustained viral control with improved immunologic status can be a realistic goal for most individuals in clinical care.
    Full-text · Article · Feb 2013
    • "The lack of sufficient mental health services in the HIV clinics amplified the providers' tendency to prescribe antidepressants and act as " therapists, " as one stated. Preventively prescribing antidepressants to patients on IRT because of insufficient psychiatric support (Weiss & Morgello, 2009), adopting a multidisciplinary approach that includes mental health and substance use services, and spending additional time with the patient (Fuller et al., 2009) were recently identified in the literature as essential for increasing IRT's uptake. Discussions of engaging their coinfected patients in HCV therapy revealed that providers integrated in their practice another key dimension of patient-centered medicine: understanding the meaning the illness has for the patient (Mead & Bower, 2000). "
    [Show abstract] [Hide abstract] ABSTRACT: Despite the high prevalence of hepatitis C virus (HCV) infection among injection drug users also infected with human immunodeficiency virus (HIV), and the synergistic adverse effect of the two diseases on patients' health and survival, research on the clinical management of these patients and particularly the low uptake of HCV therapy is limited. We conducted qualitative interviews with 17 HIV providers from two urban public hospitals. We discovered that the limitations of the current state of medical knowledge, the severe side effects of HIV and HCV therapies, and the psychosocial vulnerability of HIV/HCV-coinfected patients combined with their resistance to becoming informed about HCV posed significant challenges for providers. To contend with these challenges, providers incorporated key dimensions of patient-centered medicine in their practice, such as considering their patients' psychosocial profiles and the meaning patients assign to being coinfected, and finding ways to engage their patients in a therapeutic alliance.
    Article · Aug 2011
  • Article · · Qualitative Health Research
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