Background Hepatitis C virus (HCV) cure rates have been similar in patients with and without HIV co-infection; however, in the ION-4 study, black patients treated with ledipasvir/sofosbuvir were significantly less likely to achieve cure (90%) compared to non-black patients (99%). There are limited real world data on the effectiveness of oral direct acting antivirals (DAAs) in predominantly minority HIV/HCV co-infected populations. Methods We analyzed HCV treatment outcomes among 255 HCV co-infected patients initiating DAAs between February 2014 and March 2016 in an urban clinic in Baltimore, Maryland. To facilitate adherence, patients received standardized HIV nurse/pharmacist support which included nurse visits and telephone calls. Results The median age was 43 years, 88% were black, 73% male, 69% had a history of injection drug use, 45% a history of hazardous alcohol use and 57% a comorbid psychiatric diagnosis. Median CD4 count was 577 (IQR 397–820) cells/mm3; most (97%) were on antiretroviral therapy, had HIV RNA <20 copies/ml (87%) and were infected with HCV genotype 1 (98%). Over 60% had significant fibrosis [FIB4 score 1.45–3.25 (44%) and >3.25 (17%, cirrhosis)] and 30% were HCV treatment experienced. The majority of patients received ledipasvir/sofosbuvir with or without ribavirin (91%) and were treated for 12 weeks. Overall, the sustained virologic response rate was 97% (95% confidence interval [CI] 93–98) and did not vary by race (black, 96% [95% CI 93–98]; Non-black 97%, [95% CI 83–99]), history of injection drug use, alcohol use or psychiatric diagnosis. Conclusion HCV treatment was highly effective among HIV-infected patients who received care within an integrated nurse/pharmacist adherence support program. These results suggest that race and psychosocial comorbidity may not be barriers to HCV elimination.

Background.Hepatitis C is a major cause of mortality among human immunodeficiency virus (HIV)-infected patients, yet hepatitis C virus (HCV) treatment uptake has historically been low. Although the removal of interferon removes a major barrier to HCV treatment uptake, oral therapies alone may not fully eliminate barriers in this population.Methods.Within the Johns Hopkins Hospital HIV cohort, a nested case-control study was conducted to identify cases, defined as patients initiating HCV treatment between January 1996 and 2013, and controls, which were selected using incidence density sampling (3:1 ratio). Controls were matched to cases on date of enrollment. Conditional logistic regression was used to evaluate factors associated with HCV treatment initiation.Results.Among 208 treated cases and 624 untreated controls, the presence of advanced fibrosis (odds ratio [OR], 2.23; 95% confidence interval [CI], 1.26–3.95), recent active drug use (OR, 0.36; 95% CI, 0.19–0.69), and non-black race (OR, 2.01; 95% CI, 1.26–3.20) were independently associated with initiation of HCV therapy. An increasing proportion of missed visits was also independently associated with lower odds of HCV treatment (25%–49% missed visits [OR, 0.49; 95% CI, 0.27–0.91] and ≥50% missed visits [OR, 0.24; 95% CI, 0.12–0.48]).Conclusions.Interferon-free treatments may not be sufficient to fully overcome barriers to HCV care in HIV-infected patients. Interventions to increase engagement in care for HIV and substance use are needed to expand HCV treatment uptake.

Background/AimAs Thai people living with HIV/AIDS gain increasing access to antiretroviral (ARV) therapy, it is important to evaluate the impact this has not only on clinical outcomes, but also on patients' functional status and well-being. In this study, we translated, culturally adapted and tested the reliability and validity of two widely-used health-related quality of life questionnaires - the MOS-HIV Health Survey and the SF-12 - in people living with HIV/AIDS in Northern Thailand. Methods: Questionnaires were administered to 100 patients at community hospital outpatient ARV clinics in northern Thailand. Reliability was estimated using Cronbach's alpha, while evidence for validity was tested using known-groups comparison based on CD4 group, symptom distress score, bed days and days of reduced activity in the past three months.ResultsPatients' median age was 36, with 58% female, 58% working as laborers, and 60% completing at least primary education. Median CD4 count was 218 cells/mm3. There were no missing data. For the MOS-HIV and SF-12, mean physical summary scores were 53.1 and 49.0 respectively; mean mental summary scores were 53.4 and 45.6, respectively. Internal consistency coefficients were >0.7 for all but one scale, the PF scale (0.67). As hypothesized, scores were slightly to moderately correlated with CD4 count, symptom score, number of days in bed or with reduced activity. Correlations were higher with physical health scores than with mental health scales. The MOS-HIV discriminated clinical known groups slightly better than the SF-12.ConclusionBoth the MOS-HIV and the shorter SF-12 were successfully adapted for people with HIV/AIDS in Northern Thailand, and showed encouraging evidence for reliability and validity. These patient reported questionnaires could be valuable tools in evaluating therapeutic interventions and other innovations in health and social services, and to estimate health needs and population disability related to HIV.