Hepatitis C Treatment Experiences and Decision-Making Among Patients Living with HIV InfectionAbstract Hepatitis C infection is a major problem for approximately 250,000 HIV-infected persons in the United States. Although HIV infection is well controlled in most of this population, they suffer liver-associated morbidity and mortality. Conversely, HCV treatment uptake remains quite low (15-30%). Therefore, the purpose of this qualitative study was to explore HCV treatment experiences and decision-making in adults with HIV infection. The study sample included 39 co-infected adults, 16 in the HCV-treated cohort (who were interviewed up to 3 times) and 23 in the HCV-non-treatment cohort. Analysis of interviews identified 2 treatment barriers (fears and vicarious experiences) and 4 facilitating factors (experience with illness management, patient-provider relationships, gaining sober time, and facing treatment head on). Analysis of these data also revealed a preliminary model to guide intervention development and theoretical perspectives. Ultimately, research is urgently needed to test interventions that improve HCV evaluation and treatment uptake among HIV-infected patients.
Keywordsdecision-making; Hepatitis C; HIV Treatment of HIV-infected persons with combination antiretroviral therapy (ART) in the past decade has altered the spectrum of liver disease. Liver abnormalities in this population are now less commonly due to opportunistic infections and neoplasm; the most prevalent liverassociated problem is hepatitis C virus (HCV; Bica et al., 2001;Sulkowski, Moore, Mehta, & Chaisson, 2002). The proportion of liver-related deaths among HIV-infected adults in the United States has increased 3-to 4-fold (Selik, Byers, & Dworkin, 2002). Even more striking, more than half (54.6%) of those HIV-infected patients who died of liver-related causes Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. HIV and HCV infections interact biologically. HIV infection is associated with higher HCV RNA levels and a more rapid progression of HCV-related liver disease (Zylberger & Pol, 1996). In a paired biopsy study, HIV infection was found to accelerate the rate of fibrosis progression by 1.4-fold and the development of advanced fibrosis 3-fold (Mohsen et al., 2003). Severity of liver fibrosis is also related to HIV infection-induced CD4 cell depletion (Puoti et al., 2001). A low CD4 cell count was independently associated with advanced HCV disease and correlated with a higher histological index (Mohsen et al., 2003). Therefore, in patients infected only with HCV, the time between infection an...