The Syndemics of HIV, Hepatitis, and Overdose

Sara ZeiglerAssociate Director for Policy

Office of Policy, Planning and Partnerships (proposed)

Centers for Disease Control and PreventionNational Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention

USCA Hepatitis Pathway SessionSeptember 7, 2018

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB PreventionOffice of the Director

Massive Increase in Opioid Deaths in United States

Over 600,000 people have died from opioid overdose

since 2000

Source: National Notifiable Diseases Surveillance System (NNDSS)

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15,000

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Hepatitis B

Hepatitis C

Over 22,000 Americans die of viral hepatitis each year

Acute Hepatitis C Infections Continue to Soarand Progress Combatting Hepatitis B is Threatened

Increased Transmission of Viral Hepatitis to Infants

• Without preventive treatment, 40% of infants born to HBV-infected mothers will develop chronic infection• Without treatment, a quarter will

die from liver disease

• From 2009-2014, HCV infection among women giving birth nearly doubled

MMWR, May 12, 2017; https://www.cdc.gov/hepatitis/hbv/perinatalxmtn.htm

Hepatitis A Outbreaks in Multiple States

• CDC has been assisting with multi-state hepatitis A outbreaks– Primarily among homeless persons,

persons who use injection and non-injection drugs, and their close contacts

– More than 5,118 cases; 63 deaths– Over 3,058 hospitalizations

Drug Overdose Death Rates

SOURCE: CDC/NCHS Data Visualization Gallery 2016

Reported New HCV Infections

SOURCE: CDC National Notifiable Disease Surveillance System 2013-14

Drug Overdoses and Hepatitis C: Interconnected Epidemics

45,200

38,500

35,000

40,000

45,000

50,000

2008 2015

Annual HIV infections in the U.S. declined 15% from 2008-2015, then plateaued

15%

Prevented 34,000 cases at estimated cost savings for medical care of over $16 billion*Note. Estimates were derived from a CD4 depletion model using HIV surveillance data. *Farnham PG et al. Updates of Lifetime Costs of Care and Quality of Life Estimates for HIV-Infected Persons in the United States: Late Versus Early Diagnosis and Entry Into Care. JAIDS 2013; 64: 183-189. Estimates updated to 2017 dollars.

One in 10 new HIV infections occur among

people who inject drugs -- a decade of progress

now threatened.

WHAT WORKS?

Comprehensive Community Action Works

MacArthur BMJ 2012. Aspinall E J et al. Int J. Epidemiology, 2014; Turner Addiction 2011; Hagan J Sub Abuse Treatment 2000; Sypsa JID 2017

Mobilize multi-sector community action• health care• education agencies• public health• law enforcement

Comprehensive syringe services programs (SSPs)

• stopping use of drugs• prevent infections • link patients to treatment• do not increase drug use or crime

Targeted Disease Prevention Strategies

• Respond quickly and comprehensively to Hepatitis A clusters• Implement targeted vaccination strategy

• Ensure Hepatitis B vaccines and testing are reaching the people who need them

• Increase screening, diagnosis, and treatment of Hepatitis C and reduce barriers to treatment access

• Cost of treatment is decreasing• 2014: $83,000–$153,000• 2017: About $40,000

Rapid and Comprehensive Outbreak Response Makes All the Difference

• 233 people with HIV• ~90% had hepatitis C co-infection• 5% adults with HIV (population 3,143)• Over $100 million in lifetime medical costs

Credit: Tyler Stewart / Associated Press

Comprehensive community based prevention services worked

Essential partnerships with law enforcement, schools, healthcare, and others

Continued focus on adherence to treatment

44 states and Puerto Rico have areas that are experiencing, or at risk for, increases or outbreaks of HCV/HIV

CDC Resource: Managing HIV and

hepatitis C outbreaks among

persons who inject drugs - A guide for

state and local health departments

• $478,000: lifetime cost to treat someone with HIV infection

• For every $1 CDC spent on HIV testing, $2 were saved in direct medical costs

• $6.5 billion: estimated total healthcare costs associated with hepatitis C infection in 2011

• The average cost of curing people with hepatitis C is not only cost-effective, but cost-saving to the healthcare system

Prevention of Harmful Opioid Use

Prevention of Viral Hepatitis and HIV

Treatment of Substance Use

Disorder Linkage to

Care and Treatment

Comprehensive action will reduce drug use, save money, and save lives.