Breaking Down the Barriers to Hepatitis C Virus (HCV) Treatment Among Individuals With HCV/HIV Coinfection: Action Required at the System, Provider, and Patient Levels

Abstract

The majority of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) coinfection occurs among persons who inject drugs. Rapid improvements in responses to HCV therapy have been observed, but liver-related morbidity rates remain high, given notoriously low uptake of HCV treatment. Advances in HCV therapy will have a limited impact on the burden of HCV-related disease at the population-level unless barriers to HCV education, screening, evaluation, and treatment are addressed and treatment uptake increases. This review will outline barriers to HCV care in HCV/HIV coinfection, with a particular emphasis on persons who inject drugs, proposing strategies to enhance HCV treatment uptake and outcomes.

Human rights and access to hepatitis C treatment for people who inject drugs

“…Treatment adherence among PWID was 82% across the different studies, again comparable to other patients (Aspinall et al, 2013). Though risk of reinfection has been cited as a reason not to treat PWID for HCV (Grebely, Oser, Taylor, & Dore, 2013), it is sharing of contaminated injecting equipment, rather than drug using status, that causes infection, and available data suggest that reinfection risk is low even in persons who continue injecting after treatment (Grady, Schinkel, Thomas, & Dalgard, 2013).…”

Elimination of hepatitis C virus infection among PWID: The beginning of a new era of interferon-free DAA therapy

“…Although interferon-based HCV therapy is safe and effective among PWID (Aspinall, et al, 2013;Dimova, et al, 2013;Hellard, Sacks-Davis, & Gold, 2009), patient, provider, health system, structural, and societal barriers (Grebely, Oser, Taylor, & Dore, 2013;Harris & Rhodes, 2013;Wolfe, et al, 2015) have led to low diagnosis and treatment for HCV infection in the interferon-era (Alavi, et al, 2014;Iversen, et al, 2014). The availability of tolerable and simple direct-acting antiviral (DAA) therapies for HCV infection with cure rates >95% represents one of the greatest medical advances in decades FaladeNwulia, et al, 2017).…”

Immigration and viral hepatitis

“…Over four years, this program reached one million people, educated 11,000 and screened 9000 Asian migrants living in New York City. Other initiatives have aimed at educating primary care providers, in order to improve their knowledge and comfort with managing viral hepatitis and its complications [72,73]. In order to be successful, outreach programs require buy-in from the target community, ongoing efforts to raise awareness, and a linkage to care for screen-positive individuals [74].…”