A Comparison of Treatment Eligibility for Hepatitis C Virus in HCV-Monoinfected Versus HCV/HIV-Coinfected Persons in Electronically Retrieved Cohort of HCV-Infected Veterans

Abstract

Treatment rates for hepatitis C virus (HCV) are low in actual clinical settings. However, the proportion of patients eligible for treatment, especially among those coinfected with HIV, is not well known. Our aim was to determine and compare the rates for HCV treatment eligibility among HCV and HCV-HIV-coinfected persons. We assembled a national cohort of HCV-infected veterans in care from 1998-2003, using the VA National Patient Care Database for demographic/clinical information, the Pharmacy Benefits Management database for pharmacy records, and the Decision Support Systems database for laboratory data. We compared the HCV-monoinfected and HCV-HIV-coinfected subjects for treatment indications and eligibility using current treatment guidelines. Of the 27,452 subjects with HCV and 1225 with HCV-HIV coinfection, 74.0% and 84.6% had indications for therapy and among these, 43.9% of HCV-monoinfected and 28.4% of HCV-HIV-coinfected subjects were eligible for treatment. Anemia, decompensated liver disease (DLD), chronic obstructive pulmonary disease (COPD), recent alcohol abuse, and coronary artery disease were the most common contraindications in the HCV, and anemia, DLD, renal failure, recent drug abuse, and COPD in the HCV-HIV-coinfected group. Among those eligible for treatment, only 23% of the HCV-monoinfected and 15% of the HCV-HIV-coinfected subjects received any treatment for HCV. Most veterans with HCV are not eligible for treatment according to the current guidelines. Even for those who are eligible for treatment, only a minority is prescribed treatment. Several contraindications are modifiable and aggressive management of those may improve treatment prescription rates.

Barriers to Hepatitis C Antiviral Therapy in HIV/HCV Co-Infected Patients in the United States: A Review

“…In one study, 26% of veterans with co-infection were diagnosed with this condition. 36 Diagnoses of decompensated liver diseases in these veterans were defined as elevated INR (> 1.3), elevated total bilirubin (> 2.0 mg/dL), low albumin (< 2.5 g/dL), esophageal varices, ascites, or hepatic encephalopathy. Half of all studies (n = 8) cited severe, uncontrolled psychiatric illness, including depression, as an absolute contraindication.…”

“…Severe, uncontrolled co-morbidities were barriers in six articles; co-morbidities were most often due to cardiac disease when a specific condition was listed. 29,36,37 Renal insufficiency and/or renal failure was a treatment barrier in four studies. The highest prevalence was in one of the studies by Butt et al, wherein 19% of veterans had renal failure, defined as elevated serum creatinine (> 1.5 mg/dL).…”

“…The highest prevalence was in one of the studies by Butt et al, wherein 19% of veterans had renal failure, defined as elevated serum creatinine (> 1.5 mg/dL). 36 Only one study cited active, uncontrolled autoimmune disease as an absolute contraindication. 24 Data were retrieved through patient self-report or via medical chart abstraction and was a contraindication for 12% of veterans.…”

Majority of HIV/HCV Patients Need to Switch Antiretroviral Therapy to Accommodate Direct Acting Antivirals

“…[12][13][14] Consequently, less than 15% of co-infected patients had received treatment for HCV as of 2011. 15 The landscape of hepatitis C treatment was transformed with the approval of sofosbuvir (SOF), an NS5B inhibitor, and simeprevir (SMV), an NS3/4A protease inhibitor, in 2013. For the first time, an all oral, interferon-free HCV treatment option became available.…”

Treatment of Genotype 1 HCV Infection in the HIV Coinfected Patient in 2014

“…The management of the HIV-HCV coinfected patient can be complicated by comorbidities, including substance abuse and psychiatric disease, which may limit or exclude HCV treatment [9, 10]. Often referred to as “difficult to treat,” this patient population has now become one in desperate need of new HCV therapies.…”