Hepatitis C Virus and Human Immunodeficiency Virus Coinfection in an Urban Population: Low Eligibility for Interferon Treatment

Abstract

One hundred eighty human immunodeficiency virus (HIV)- and hepatitis C virus (HCV)-coinfected patients were prospectively evaluated for suitability for interferon and ribavirin therapy. Of the 149 patients with chronic HCV infection who completed the evaluation, 44 (30%) were eligible for treatment and 105 (70%) were ineligible, with the main barriers being missed clinic visits, active psychiatric illness, active drug or alcohol use, decompensated liver disease, or medical illness.

Cost-effectiveness of Treatment for Hepatitis C in an Urban Cohort Co-infected with HIV

“…18 We followed the recommendations of the US Panel on Cost-Effectiveness in Health and Medicine, 19 adopting a societal perspective (although we excluded patient time costs) and discounting all costs and clinical consequences at a rate of 3% per year. The comparative efficiencies of alternative treatment strategies were measured by the incremental costeffectiveness ratio, defined as the additional cost of a specific treatment strategy divided by its additional health benefit, expressed here as years of life saved (YLS).…”

Injection Drug Use and the Hepatitis C Virus: Considerations for a Targeted Treatment Approach--The Case Study of Canada

“…In an urban population of HIV and HCV co-infected patients in Boston, Massachusetts, assessed for suitability for interferon treatment, 70% were deemed ineligible by infectious disease and hepatology staff in a medical clinic, with active drug or alcohol use cited as one of the main reasons. 115 Although the exclusion of illicit drug users from HCV treatment has been rationalized for the most part by specific "contraindications" relating to active drug use, psychiatric comorbidity, and concerns with adherence, 108,1156 the categorical barring of illicit drug users from HCV treatment is being questioned. 84,116 Rather, it can be argued that stigma and systemic and ideological factors may reflect a populationspecific form of discrimination 117 that leads to IDUs being denied treatment.…”

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

“…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.…”

“…[13][14][15][16] Among genotype 1 and 4 patients, HCV treatment has generally been recommended for patients with at least moderate signs of fibrosis and inflammation of the liver; however, some recommend that coinfected patients with minimal or no fibrosis should also be considered for treatment. 22 Late stage, decompensated liver disease and advanced immunosuppressiona (i.e., low CD4 count) are common reasons for coinfected patients being excluded from HCV treatment, 7 and HCV treatment has been shown to be more successful among HIV patients with higher CD4 counts and milder liver disease. [23][24][25] This suggests the need to closely monitor patients and to initiate treatment prior to both HCV and HIV disease becoming too advanced.…”

“…7,27 Substance abuse and mental illness each account for 20%-30% of coinfected patients being deemed ineligible for treatment, as clinicians are concerned that the side effects of HCV treatment may lead to psychiatric deterioration, relapse into substance abuse, poor adherence, and treatment discontinuation. [6][7][8]27,28 Psychiatric and substance abuse patients have been excluded from most clinical trials, but the little data available show mixed results; some studies find that such patients do equally as well in terms of ability to complete and respond to treatment, [29][30][31] while others suggest that patients with active substance abuse and psychiatric problems are less likely to respond and more likely to drop out of treatment. 32,33 Characteristics of the provider and clinic organization can also influence HCV treatment decisions.…”