Prof Massimo Colombo, Editor-in-Chief of the “Hepatitis B and C Public Policy Association’s Newsletter”, poses some questions to our Dr Boschini for the July issue of the newsletter:
Dr Boschini, how many PWIDs are currently hosted by the Community?
In reality at the moment our community is host to about 1228 people, all of them are in recovery for addiction to illegal substances (DU), of these there are 681 (55,5%) who consumed their drugs intravenously. (PWID)
How long do they stay for rehabilitation and how frequently are they found to be chronically infected by HBV and HCV?
Our therapeutic program lasts for four years. This is a residential therapeutic program that is essentially based on education, rehabilitation and professional training for reintegration. We do not use drug replacement therapy; we only prescribe psychopharmacological treatments for those people that have a double diagnosis, that amount being about 23% of the residents, in other words they have a psychiatric condition as well as a dependence to drugs. There is a need for individual psychotherapy for approximately 30% of our guests, not for the treatment of addiction but problems that are related to addiction, such as sexual abuse, PTSD, eating disorders, etc.
The prevalence of HCV, HBV, and HIV infections in the people that are in treatment is 34%, 0,6%, and 3,2% respectively; if the analysis is further limited to the group PWID the prevalence is 59,4%, 0,7%, and 7,2% respectively.
What is the standard of care in terms of life style and surveillance and therapy of viral hepatitis?
Within our Community there is a medical center which includes a health center, two hospital wards with a total of 50 beds, for patients with serious diseases or illnesses related to their drug use (AIDS, cirrhosis, cancer, neurological diseases, tuberculosis, etc.), a laboratory for blood and urine analysis (in which we have stored serum and plasma samples of more than 20,000 people), physiotherapy, etc.
Every subject, after admission, undergoes a medical screening that includes: (a) toxicological and clinical medical history; (b) medical examination; (c) chest x ray; (d) PPD skin test; (e) ECG; (f) spirometry; (g) blood chemistry analysis which includes, HIV, HBV, HCV, and Syphilis serology. Those who result HCV (or HBV) antibody positive undergo ECO, HCV RNA and genotyping (HBV DNA, HDV antibodies) are from this point on regularly tested for evaluation and maintenance.
Until 2013 patients with chronic HCV infection were treated, if eligible, with pegylated interferon plus ribavirine, but most of them suffered for neuropsychiatric side effects, a side effect more frequent in former drug users than in other populations. Now Interferon based treatment is prescribed only in those patients with genotype 3 infection (in our population there are no genotype 2 infected patients) with a recent HCV infection (less than 10 years), without psychiatric symptoms and negative anamnesis for psychiatric diseases.
How many are treated with IFN free DAAs?
To date 20 patients, all affected by cirrhosis or HCC, have been treated with IFN free treatments.
Is there a Scientific Committee to supervise management of medical and social problems of inmates?
A Scientific Committee, was founded in 1984, oversees the medical needs of the community’s residents and evaluates all the scientific research projects that the community intends to pursue, or in which it is already involved.
What are the initiatives undertaken by the SC for 2017 ?
In the near future we are intending to equip our medical center with a FibroScan , this will enable us to effectively and accurately scan our guests infected with the HCV disease, and also, identify all those who fall within the Italian guidelines (AIFA) for access to or qualifying for the treatments with DAA. We are hoping to have it installed and working by the end of July 2016.
As is already occurring in other healthcare and clinical services, through the NHS we intend to accredit and establish diagnostic activities with FibroScan, this will give the opportunity for
outpatients to tale advantage of our facilities, thus avoiding waiting lists for outside testing which can be as long as 4 – 5 months.
For 2017 our goal is to treat as many patients as possible, absolutely all of those co-infected with HCV and HIV and HCV and HBV, those with fibrosis> 3, and possibly even some patients with a less advanced fibrosis.