Psychiatric illness and illicit drugs as barriers to hepatitis C treatment among HIV/hepatitis C virus co-infected individuals

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.…”

“…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.…”

Hepatitis C treatment in “difficult-to-treat” psychiatric patients with pegylated interferon-alpha and ribavirin: Response and psychiatric side effects

“…13,[15][16][17] In addition, reports of suicide attempts during IFN-␣ therapy and the risk of reinfection led to the opinion that the use of INF-␣ is contraindicated for patients with a preexisting mental disorder, ongoing opiate abuse, or methadone substitution. 18,19 As a consequence, most of these patients remain untreated despite fulfilling the medical criteria for antiviral treatment of chronic hepatitis C. 17,20 The arguments for excluding these patients from treatment often do not stem from the results of suitable prospective and controlled clinical studies that included patients who were drug users or had psychiatric disorders. 21 We recently demonstrated that psychiatric-risk patients with hepatitis C who were treated with standard interferon alpha plus ribavirin had response and dropout rates and an incidence of new major depressive episodes comparable to those of nonpsychiatric controls.…”