Damar Yoluyla Madde Kullananlarda Son Dönemde IV Madde Kullanımının ve Psikiyatrik Belirti Şiddetinin Antiviral Tedaviye Etkisi

Amaç: Damar içi madde kullanan kişilerin hepatit C virüsü (HCV) enfeksiyonlarındaki artışa büyük katkısı vardır. Doğrudan etkili antiviral (DEA) tedavilerin etkinliği ve güvenliğine rağmen, hastalar tedaviye ulaşmakta zorluk çekebilirler. Bu çalışmada madde kullanıcılarında klinik değişkenlerin antiviral tedaviye erişim ve tedavi oranlarına etkisini incelemeyi amaçladık. Yöntem: Bu retrospektif çalışmada Temmuz 2020-Nisan 2021 tarihleri arasında Ayaktan Arındırma Merkezi'ne (AAM) başvuran 5586 hastanın dosyası tarandı, Anti-HCV pozitif çıkan 121 hastanın dosyası incelenmiş ve eksik veri bulunan dosyalar dahil edilmemiştir. Tüm hastaların geçmişte Bağımlılık Profil İndeksi (BAPİ) ve Yetişkin Dikkat Eksikliği Hiperaktivite Bozukluğu Kendini Değerlendirme Ölçeği (ASRS) sonuçları rutin olarak mevcuttu. Bulgular: Hastaların en çok kullandığı madde opiyattı. Sigorta kısıtlamaları nedeniyle, DEA tedavisi yalnızca üçüncü basamak hastanelerde reçete edilebildiğinden, çalışmaya alınan tüm hastalar üçüncü basamak bir hastaneye sevk edilmişti. Anti-HCV tarama testinden antiviral tedaviye kadar geçen ortalama süre 190,3 gündü. Aktif iv madde kullanıcılarının her gün madde kullanma oranı daha yüksek (%81,5 e %41,5), mevcut maddeyi daha genç yaşta kullanmaya başlama oranları (%19,1 e %20,9) ve toplam BAPİ puanları daha yüksek, depresyon (4,7 e 3,7, p=0,022), anksiyete alt ölçek puanları ve ASRS-A puanları daha yüksekti (11,3 e 8,3). Aktif iv madde kullanıcılarını ile hayat boyu iv kullanıcıları karşılaştırıldığında, Anti-HCV testi – tedavi süresi (100,4 ve 254,5) ve antiviral tedaviyi tamamlama oranları açısından fark yoktu (%100 e %67,7). Sonuç: Yüksek tedavi oranlarını gösteren kapsamlı verilere rağmen, iv madde kullanıcıları için tedavi oranları kabul edilebilir olmaktan uzak görünmektedir. Aktif damar içi madde kullanan kişileri ayrıştıran faktörlerin analizi iv kullanımı sonlandırmak açısından önem taşısa da, antiviral tedavi kararı geciktirilmemelidir.

Anahtar Kelimeler:

Hepatit C, İntravenöz, Opiyat, Madde

Effects of Recent IV Drug Use and Severity of Psychiatric Symptoms to Antiviral Treatment in People Who Inject Drugs

Objective: People who inject drugs have major contribution to a rise in hepatitis C virus (HCV) infections. Despite efficacy and safety of direct-acting antiviral (DAA) therapies, patients may have difficulties to receive treatment. In this study we aimed to examine the effect of clinical variables in substance users to access to antiviral treatment and the treatment rate. Method: In this retrospective study, we examined the files of 5586 patients who admitted to Outpatient Treatment Center (OTC) between July 2020-April 2021 and files of 121 patients with positive Anti-HCV results were included. All patients had been routinely assessed by Addiction Profile Index (API) and Adult Attention Deficit Hyperactivity Disorder Self-Rating Scale (ASRS).. Results: Of 121 patients, the most used substance was opiate. Because of the insurance restrictions, DAA treatment might be prescribed in only tertiary referral hospitals. All patients had been referred to a tertiary referral hospital. The mean duration from Anti-HCV testing to treatment was 190.3 days. Actively iv substance users were more likely to use substances every day ( 81.5 % vs 41.5%), start using the current substance at younger age (19.1 vs 20.9), have higher total API scores, have higher depression (4.7 vs 3.7), anxiety subscale scores, and ASRS-A scores (11.3 vs 8.3). Actively iv substance users were no more likely to have longer Anti-HCV – treatment duration (100.4 ve 254.5) and have worse treatment completion rates (% 100 vs 67.7). Conclusion: According to research findings, young adults' expectations to obtain social status and social conformity through the acquisition of a product may affect spending time for online shopping and they may lose control of the use of credit cards.

Keywords:

Hepatitis C; Substance; Intravenous; Opiate,

PDF

___

REFERENCES 1. Scott, N., Doyle, J.S., Wilson, D.P. et al. Reaching hepatitis C virus elimination targets requires health system interventions to enhance the care cascade. Int J Drug Policy 2017:47;107-16.
2. Wiessing, L., Ferri, M., Grady, B., et al. Hepatitis C virus infection epidemiology among people who inject drugs in Europe: a systematic review of data for scaling up treatment and prevention. PLoS One 2014: 9(7):e103345.
3. Iversen, J., Grebely, J., Catlett, B., et al. Estimating the cascade of hepatitis C testing, care and treatment among people who inject drugs in Australia. Int J Drug Policy 2017:47;77-85.
4. Grebely, J., Applegate, T.L., Cunningham, P., Feld, J.J. Hepatitis C point-of-care diagnostics: in search of a single visit diagnosis. Expert Rev Mol Diagn 2017;17:1109-15.
5. World Health Organization. Global Hepatitis Report, 2017.
6. Hagan, H., Pouget, E.R., Des Jarlais, D.C. A systematic review and meta-analysis of interventions to prevent hepatitis C virus infection in people who inject drugs. J Infect Dis 2011;204(1):74-83.
7. Kessler RC, Adler L, Ames M, et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med. 2015;35(2):245-56.
8. Doğan, S., Öncü, B., Varol-Saraçoğlu, G., Küçükgöncü, S. Validity and reliability of the Turkish version of the Adult ADHD Self-Report Scale. Anatolian Journal of Psychiatry 2009;10:78-87.
9. Ögel, K., Evren, C., Karadağ, F., Tamar Gürol, D. Development, Validity and Reliability Study of Addiction Profile Index. Turk Psikiyatri Derg. 2012 Winter 23(4):263-75.
10. Butler, K., Day, C., Dietze, P., et al. The potential reach of opioid substitution settings to deliver HCV care to people who inject drugs in Australia. J Sub Abu Tre 2015;58:90-94.
11. Akiyama, M.J., Lipsey, D., Heo, M., et al. Low Hepatitis C reinfection following direct-acting antiviral therapy among people who inject drugs on opioid agonist therapy. Clinical Inf Dis 2020;70(12):2695-2702.
12. Robaeys, G., Bielen, R., Azar, D.G., et al. Global genotype distribution of hepatitis C viral infection among people who inject drugs. J Hepatol 2016;65(6): 1094-1103. doi: 10.1016/j.jhep.2016.07.042.
13. Sanvisens, A., Rivas, I., Faure, E., et al. Monitoring hepatitis C virus treatment rates in an opioid treatment program: A longitudinal study. World J Gastroenterol 2020;26(38):5874-5883.
14. Erman Daloğlu, A., Parkan, Ö.M., Erdoğan, A., et al. Distribution of hepatitis C virus genotypes among intravenous drug and non-drug user patients. Mikrobiyol Bul 2021;55(1):30-40. doi: 10.5578/mb.20108.
15. Aspinall, E.J., Corson, S., Doyle, J.S., et al. Treatment of hepatitis C virus infection among people who are actively injecting drugs: a systematic review and meta-analysis. Clin Infect Dis. 2015;57 Suppl 2:S80-9.
16. Trooskin, S.B., Dore, G., Kostman, J. We must do better: Addressing HCV treatment barriers in persons who inject drugs in the United States. J of Inf Dis 2020;222(S9):773-781.
17. Rosenthal, E.S., Silk, R., Mathur, P., et al. Concurrent Initiation of Hepatitis C and Opioid Use Disorder Treatment in People Who Inject Drugs. Clinical Infectious Diseases 2020;71(7): 1715–1722.
18. Akiyama, M.J., Norton, B.L., Arnsten, J.H., et al. Intensive models of hepatitis C care for people who inject drugs receiving opioid agonist therapy: a randomized controlled trial. Ann Intern Med 2019;170:594-603.
19. Muller, A., Vlahov, D., Akiyama, M.J., Kurth, A. Hepatitis C reinfection in people who inject drugs in resource-limited countries: a systematic review and analysis. Int J Environ Res Public Health 2020;17(14):4951.
20. Zeremski, M., Zibbell, J.E., Martinez, A.D., et al. Hepatitis C Virus control among persons who inject drugs requires overcoming barriers to care. World J Gastroenterol 2013:19:7846-7851.
21. Wilens, T.E. Impact of ADHD and its treatment on substance abuse in adults. J Clin Psychiatry 2004;65 Suppl 3:38-45.
22. Tapert, S.F., Baratta, M.V., Abrantes, A.M., Brown, S.A. Attention dysfunction predicts substance involvement in community youths. J of American Academy of Child and Adolescent Psychiatry 2020;41(6):680-686.
23. Fernández de Cañete Camacho, J.C., Mancebo Martínez, A., García Mena, M.A., Moreno Planas, J.M. Influence of psychiatric disorders and opioid substitution therapy on hepatitis C treatment with direct-acting antivirals in people who inject drugs. Gastroenterol Hepatol. 2022;45(4):265-273.
24. Pericot-Valverde, I., Heo, M., Niu, J., et al. Relationship between depressive symptoms and adherence to direct-acting antivirals: Implications for Hepatitis C treatment among people who inject drugs on medications for opioid use disorder. Drug Alcohol Depend. 2022;14;234:109403.