Trends in hepatitis C treatment initiation among HIV/hepatitis C virus-coinfected men engaged in primary care in a multisite community health centre in Maryland: a retrospective cohort study

Abstract

ObjectivesLittle is known about the cascade of hepatitis C care among HIV/hepatitis C virus (HCV)-coinfected patients in community-based clinics. Thus, we analysed our data from the interferon era to understand the barriers to HCV treatment, which may help improve getting patients into treatment in the direct-acting antivirals era.DesignRetrospective cohort study.SettingFour HIV clinics of a multisite community health centre in the USA.Participants1935 HIV-infected men with >1 medical visit to the clinic between 2011 and 2013. Of them, 371 had chronic HCV and were included in the analysis for HCV care continuum during 2003–2014.Outcome measuresHCV treatment initiation was designated as the primary outcome for analysis. Multivariate logistic regression was performed to identify factors associated with HCV treatment initiation.ResultsAmong the 371 coinfected men, 57 (15%) initiated HCV treatment. Entering care before 2008 (adjusted OR [aOR, 3.89; 95% CI, 1.95 to 7.78), higher educational attainment (aOR, 3.20; 95% CI, 1.59 to 6.44), HCV genotype 1 versus non-1 (aOR, 0.21; 95% CI, 0.07 to 0.65) and HIV suppression (aOR, 2.13; 95% CI, 1.12 to 4.06) independently predicted treatment initiation. Stratification by entering care before or after 2008 demonstrated that higher educational attainment was the only factor independently associated with treatment uptake in both periods (aOR, 2.79; 95% CI, 1.13 to 6.88 and aOR, 4.10; 95% CI, 1.34 to 12.50, pre- and post-2008, respectively). Additional associated factors in those entering before 2008 included HCV genotype 1 versus non-1 (aOR, 0.09; 95% CI, 0.01 to 0.54) and HIV suppression (aOR, 2.35; 95% CI, 1.04 to 5.33).ConclusionsSome traditional barriers predicted HCV treatment initiation in those in care before 2008; however, the patients’ level of educational attainment remained an important factor even towards the end of the interferon era. Further studies will need to determine whether educational attainment persists as an important determinant for initiating direct-acting antiviral therapies.

Viral hepatitis and the cascade of care among people living with HIV in the Asia‐Pacific

“…Despite these limitations in accessing HCV treatment [3,21,41], we observed that 95% of those receiving treatment were on DAAs. Among those tested for SVR, 90% reached HCV suppression, which is comparable to rates reported in other studies [21,38].…”

“…The HCV CoC identified that, although over half of patients with anti-HCV-positive results received HCV RNA tests, a proportion did not receive further care. Studies on barriers to HCV care have found that, in addition to costs associated with HCV testing and treatment [36], treatment refusal, injecting drug use, and stigma are also associated factors [37,38]. Stronger interventions to increase awareness, making tests and treatment more readily available, and community approaches to testing and treatment within VH programmes for PLHIV may assist in improving the proportions receiving care after a positive diagnosis.…”

Perceptions Towards HCV Treatment with Direct Acting Antivirals (DAAs): A Qualitative Analysis with Persons with HIV/HCV Co-infection Who Delay or Refuse Treatment

“…In the United States, approximately 25% of people with HIV (PWH) are co-infected with hepatitis C (HCV) [1,2], which is the leading cause of liver-related morbidity and mortality in the country [3][4][5]. HIV/HCV co-infection accelerates liver disease progression, and co-infected people are disproportionately affected by liver-related mortality and elevated mortality in general [6][7][8][9][10]. HCV infection is increasing due to the opioid epidemic, and it is estimated that 62-80% of people who inject drugs (PWID) living with HIV are coinfected with HCV [11][12][13].…”

Depressive symptoms are no longer a barrier to HCV treatment initiation in the HIV–HCV co-infected population in Canada

“…Studies in both the IFN and DAA eras conducted in people with chronic HCV infection have found psychiatric illness among the barriers to linkage to care, treatment initiation and adherence [9], [24][25][26][27]. Whether depressive symptoms continue to prevent treatment initiation in the second-generation DAA era is unknown, especially in the coinfected population, which has higher prevalence of depression.…”