Barriers to treatment of hepatitis C in HIV/HCV coinfected adults in Brazil

Mendes-Corrêa, Maria Cássia; Martins, LG; Tenore, S; Leite, OH; Leite, AG; Cavalcante, AJW; Shimose, M; Silva, MH; Uip, DE

doi:10.1590/s1413-86702010000300007

Cited by 3 publications

(4 citation statements)

References 17 publications

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“…We did not look at rates of psychiatric illness or history of non-adherence, which have previously been associated with non-treatment. 14 We did find, however, that a large proportion of our participants had low income (61% with an annual income of less than $25,000 per year) with only 29% holding private insurance. Up to 23% of the HIV-infected patients had unstable/temporary housing situations.…”

Section: Discussioncontrasting

confidence: 64%

Attitudes and potential barriers towards hepatitis C treatment in patients with and without HIV coinfection

et al. 2017

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This study aimed to assess attitudes and potential barriers towards treatment in patients with hepatitis C virus (HCV) infection, comparing those with and without HIV coinfection. A cross-sectional survey of 82 HCV-infected adults with and without HIV was conducted in greater Los Angeles between November 2013 and July 2015. Overall, there were 53 (64.6%) with HIV coinfection, 20 (25.0%) with self-reported cirrhosis, and 22 (26.8%) with a history of prior HCV treatment. Of all, 93.2% wanted HCV treatment, but 45.9% were unwilling/unable to spend anything out of pocket, 29.4% were waiting for new therapies, and 23.5% were recommended to defer HCV treatment. HIV/HCV-coinfected patients were more likely to want treatment within one year (90.2% versus 68.2%, p = 0.02), more willing to join a clinical trial (74.5% versus 8.0%, p < 0.01), more willing to take medications twice daily (86.3% versus 61.5%, p = 0.01), and more likely to prefer hepatitis C treatment by an infectious diseases/HIV physician (36.7% versus 4.0%, p < 0.01). Of all, 77.1% of coinfected patients were willing to change antiretroviral therapy if necessary to treat HCV, but only 48.0% of patients were willing to take a medication if it had not been studied in HIV-positive patients. Treatment preferences differ between HIV/HCV-coinfected and HCV-monoinfected patients. Despite a strong willingness among the study cohort to start HCV treatment, other factors such as cost, access to medications, and provider reluctance may be delaying treatment initiation.

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Section: Discussioncontrasting

confidence: 64%

Attitudes and potential barriers towards hepatitis C treatment in patients with and without HIV coinfection

et al. 2017

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“…5,38,39 The successful treatment of co-infection has reduced the morbidity and mortality of these patients, whose priority treatment should be for HCV. 18 However, reports from different regions of the world have shown that only 30% of co-infected patients are eligible for standard therapy with pegylated interferon and ribavirin for treatment of HCV 40 and, in some cases, the choice of HAART therapy for the treatment of HIV and DAA therapy for HCV treatment will depend on the patient's response and the possible interactions between the drugs. This fact justifies the need for screening of co-infection with the HCV virus in HIV patients.…”

Section: Discussionmentioning

confidence: 99%

Seroprevalence of HCV markers among HIV infected patients from Curitiba and metropolitan region

Tizzot

Grisbach²,

Beltrame

et al. 2016

Rev. Assoc. Med. Bras.

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Results: a total of 12.9% of HIV+ patients were positive for anti-HCV antibodies, 64.1% were men and 35.9% women, with mean age of 44.5 years (24-66). The frequency of HCV among men was 16.7% and among women 9.1% (p=0.06). HCV prevalence was associated to HIV infection when compared to the general population (p<10 -6 , OR=100.4; 95CI=13.7-734.9). The parenteral route of transmission was the most frequent among coinfected patients (46.1%), and the sexual transmission among HIV+/HCV-(71.8%) (p=0.02, OR=0.2; 95CI=0.1-0.7). The frequency of intravenous drug users was higher among the coinfected patients (61.5%) compared to the non coinfected (12.6%) (p<10 -6 , OR=11.1; 95CI=4.5-27.7). Conclusion: the prevalence of coinfection with HCV in HIV+ patients is 12.9%, 88 times higher than in the general population in Curitiba. The most frequent route of transmission in the coinfected patients is parenteral, but the sexual route is also representative (34.6%).

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“…A escolha do genótipo 1 se deu em função da sua substancial resistência ao tratamento antiviral e em razão de sua maior prevalência na população brasileira 4,5,12 . Para a construção da árvore de decisão foi utilizado o software TreeAge versão 2009 (TreeAge Software Inc., Williamstown, Estados Unidos) que possibilitou simular a história natural da infecção pelo VHC, em pacientes não cirróticos e virgens de tratamento contra o VHC, coinfectados pelo HIV.…”

Section: Métodosunclassified

“…Não se sabe ao certo o número de coinfectados, mas estima-se que cerca de 3% da população seja portadora dos dois vírus 3 . No Brasil, estudos realizados em diferentes unidades de saúde e regiões, apontam para uma faixa de prevalência de coinfecção em torno de 4% a 16,7% 4,5,6 . Esses trabalhos apontam ainda que a maior parcela dos indiví-duos coinfectados é portadora do genótipo 1, considerado a variação do VHC clinicamente mais agressiva e mais resistente ao tratamento farmacológico 7 .…”

Section: Introductionunclassified

Custo-efetividade da inclusão dos respondedores virológicos lentos no tratamento da hepatite C na presença da coinfecção com o HIV

et al. 2013

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Evidências recentes demonstram que respondedores virológicos lentos podem se beneficiar com a extensão do tratamento antiviral. O estudo investigou a adoção desse protocolo diante da coinfecção VHC/HIV. O objetivo foi estudar a relação de custo/efetividade da terapêutica com peguinterferon associado à ribavirina em portadores do genótipo 1 do VHC coinfectados com o HIV, comparando-se a inclusão ou não de respondedores virológicos lentos. Simulou-se por meio de um modelo de Markov a progressão da doença hepática em uma coorte hipotética de mil homens, maiores de 40 anos, considerandose a perspectiva do Sistema Único de Saúde (SUS) e horizonte temporal de 30 anos. A extensão do tratamento para respondedores lentos resultou em uma razão incremental de custo efetividade de R$ 44.171/QALY, valor abaixo do limiar de aceitabilidade proposto pela Organização Mundial da Saúde. A análise de sensibilidade não modificou os resultados alcançados. A inclusão de indivíduos coinfectados VHC/HIV respondedores virológicos lentos no protocolo de tratamento apresenta-se como uma estratégia custo-efetiva para o SUS.

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Barriers to treatment of hepatitis C in HIV/HCV coinfected adults in Brazil

Cited by 3 publications

References 17 publications

Attitudes and potential barriers towards hepatitis C treatment in patients with and without HIV coinfection

Attitudes and potential barriers towards hepatitis C treatment in patients with and without HIV coinfection

Seroprevalence of HCV markers among HIV infected patients from Curitiba and metropolitan region

Custo-efetividade da inclusão dos respondedores virológicos lentos no tratamento da hepatite C na presença da coinfecção com o HIV

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