Hepatitis C Treatment Eligibility in an Urban Population with and without HIV Coinfection

Abstract

In an urban referral clinic, 182 hepatitis C-infected adults including 110 (60%) with HIV coinfection were evaluated for pegylated interferon and ribavirin therapy. Overall, only 33% were eligible for treatment. Considering all patients together, the major barriers to treatment were nonadherence with the evaluation process (23%), refusal of treatment (10%), active substance abuse (9%), and medical contraindication (8%). There was a trend toward a higher rate of treatment eligibility in HIV coinfected patients (39% vs. 25%; p = 0.07), who were significantly more likely to be adherent with the evaluation process compared to those with hepatitis C alone (86% vs. 63%; p = <0.001). Acceptance of antiviral therapy for hepatitis C was similar between eligible persons with and without HIV. These findings highlight the need to develop interventions to improve adherence and to manage substance abuse and other comorbidities in order to maximize the impact of interferon and ribavirin therapy on urban patients with hepatitis C.

Treat Early or Wait and Monitor? A Qualitative Analysis of Provider Hepatitis C Virus Treatment Decision-Making in the Context of HIV Coinfection

“…'I didn't want them to be angry with me.' (A4) Discussion HCV treatment rates reported by providers at the three participating sites ranged from 10%, which is similar to those found in the literature, [6][7][8][9][10][11][12] to as high as 38%. With providers being the primary gatekeepers of treatment access, we sought to examine how the decision making process differs across the primary care providers at these three sites.…”

“…Given the low uptake of treatment reported in the literature, [6][7][8][9][10][11][12] and studies that report mild liver disease to be a common reason for treatment ineligibility, 28,40 it appears that most providers in the field side with those who favor the ''wait and monitor'' approach for genotype 1 and 4 patients with mild disease. This approach aims to spare the patient from having to endure a toxic treatment that for most will provide no virologic benefit, so long as the patient's liver disease does not progress significantly.…”

“…2,3 Studies show that a majority of coinfected patients have at least moderate liver inflammation or other signs of disease progression, 4,5 however, several studies published over the past 5 years have shown that less than one third of HIV coinfected patients in the United States are deemed eligible for HCV treatment, and under 10% actually receive treatment. [6][7][8][9][10][11][12] Despite the apparent discord between the need for more aggressive HCV clinical management and the low treatment rates that are generally observed, few studies have examined the treatment decision-making of providers of HIVcoinfected patients.…”

“…These readiness components account for a large proportion of the patients not being treated. [6][7][8][9][10][11][12] However, while there was general agreement on the components of readiness, there was considerable variation in how providers viewed the influence of depression and substance use in determining a patient's readiness for treatment.…”

Psychiatric behavioral aspects of comanagement of hepatitis C virus and HIV

“…The major individual barriers to HCV treatment eligibility (low motivation, active injection drug use, alcohol use, depression) are modifiable. With appropriate treatment, coinfected persons deemed at first ineligible for HCV therapy can become eligible for therapy [30,31].…”