Trends in cause-specific mortality in HIV–hepatitis C coinfection following hepatitis C treatment scale-up

Kronfli, Nadine; Bhatnagar, Sahir; Hull, Mark; Moodie, Erica E. M.; Cox, Joseph; Walmsley, Sharon; Gill, John; Cooper, Curtis; Martel-Laferrière, Valérie; Pick, Neora; Klein, Marina B.

doi:10.1097/qad.0000000000002156

Cited by 24 publications

(24 citation statements)

References 38 publications

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“…Our review identified the presence of multi‐level determinants to care, at the individual‐, provider‐ and system‐levels, indicating that a multi‐pronged approach may be necessary to optimize linkage to care for released inmates. Notably, we identified that in failing to address the social, structural and economic determinants of health, we will do little to improve the health outcomes of previously incarcerated persons living with chronic HIV or HCV infection . Since some of these determinants are shared between individuals living with HIV and HCV, the HIV‐specific barriers and facilitators identified through this review may help inform and advance linkage to HCV care strategies for released inmates.…”

Section: Discussionmentioning

confidence: 99%

Using the barriers and facilitators to linkage to HIV care to inform hepatitis C virus (HCV) linkage to care strategies for people released from prison: Findings from a systematic review

Yanes‐Lane

Dussault

Linthwaite

et al. 2019

Journal of Viral Hepatitis

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Elimination of hepatitis C virus (HCV) among short-term sentenced prison populations will require improved access to HCV care and specific strategies dedicated to linkage upon release. Prison-based HCV care has lagged behind HIV care, but much can be learned from HIV studies. We performed a systematic review to identify individual-, provider-and system-level barriers and facilitators to linkage to HCV and HIV care among released inmates. We searched MEDLINE, Scopus, the Cochrane Central Register of Controlled Trials and Embase, and performed a grey literature search for English articles published up to November 2018. Two searches were conducted, one each for HCV and HIV; 323 and 684 unique articles were identified of which two and 27 studies were included, respectively. Facilitators to linkage to HCV care included social support, having an existing primary care provider, and receipt of methadone, whereas barriers included a perceived lack of healthcare information and a lack of specialized linkage to care programs. The principal facilitators to linkage to HIV care included social support, treatment for substance use and mental illness, the provision of education, case management, discharge planning and transportation assistance. Important barriers were unstable housing, age <30 years, HIVrelated stigma, poor providers' attitudes and the lack of post-release reintegration assistance. While HCV care-specific studies are needed, much can be learned from linkage to HIV care studies. Ultimately, a multi-pronged approach, addressing several individual-level social determinants of health, and key provider-and system-level barriers may be an appropriate starting point for the development of HCV linkage to care strategies. K E Y W O R D Shepatitis C virus (HCV), HIV, linkage to care, people in prison, systematic literature review

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Section: Discussionmentioning

confidence: 99%

Using the barriers and facilitators to linkage to HIV care to inform hepatitis C virus (HCV) linkage to care strategies for people released from prison: Findings from a systematic review

Yanes‐Lane

Dussault

Linthwaite

et al. 2019

Journal of Viral Hepatitis

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“…A major limitation of our study is that it was limited to HCV serostatus only and did not account for other HCV-related factors such as active HCV infection, liver fibrosis, HCV treatment uptake, and achievement of sustained virologic response, which are known to impact mortality. 16,18,[35][36][37] Comprehensive HCV care packages for PLWH in Georgia became available only in 2011, and therefore, these data were available only for the subset of HIV/HCV co-infected persons. Sub-analysis of patients diagnosed after 2011 showed that even in this time period not all patients established HCV care, likely due to early mortality.…”

Section: Discussionmentioning

confidence: 99%

Impact of hepatitis C virus antibody positivity on mortality and causes of death in people living with HIV in Georgia

et al. 2019

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Hepatitis C co-infection in people living with HIV (PLWH) is common in Georgia. Antiretroviral therapy (ART) is widely available in the country since 2004, and from 2011, patients have unlimited access to hepatitis C virus (HCV) treatment. A retrospective nationwide cohort study included adult PLWH diagnosed between 2004–2016, who were followed up until 31 December 2017. Predictors of mortality were assessed in Cox proportional hazards regression model. A total of 4560 persons contributed 22,322 person-years (PY) of follow-up, including 2058 (45.1%, 10,676 PY) anti-HCV+ patients. After the median 4.1 years of follow-up, 954 persons died, including 615 anti-HCV+ patients. Persons with HCV had higher overall mortality compared to HIV monoinfection (5.76/100 PY vs. 2.91/100 PY, p < 0.0001). In multivariable analysis, anti-HCV positivity was significantly associated with mortality (adjusted hazard ratio: 1.42, 95% CI: 1.09–1.85). Among anti-HCV+ persons, liver-related mortality due to viral hepatitis before the availability of HCV therapy (2004–2011) was 2.11 cases per 100 PY and this decreased to 0.79 cases per 100 PY after 2011 (p < 0.0001). AIDS remained the leading cause of death prior to and after 2011. Wide availability of ART and anti-HCV therapy translated into a significant decline in mortality including due to liver-related causes. Improving earlier diagnosis will decrease excess AIDS-related mortality among people living with HIV/HCV co-infection.

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“…Finally, we needed to consider possible competing risks, specifically deaths due to liver disease, drug overdose or other reasons. In a CCC analysis for the time-period 2013-2017, overall death rates were found to be high, with rates of 23.8 per 1000 person-years (PY) for those aged 20-49 years and 38.3 per 1000 PY among those 50-80 years of age [42]. A naïve survival analysis would censor individuals at death and assume independence of censoring and event times.…”

Section: Primary Analysismentioning

confidence: 99%

Depressive symptoms are no longer a barrier to HCV treatment initiation in the HIV–HCV co-infected population in Canada

et al. 2022

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Background Psychiatric illness was a major barrier for HCV treatment during the Interferon (IFN) treatment era due to neuropsychiatric side effects. While direct acting antivirals (DAA) are better tolerated, patient-level barriers persist. We aimed to assess the effect of depressive symptoms on time to HCV treatment initiation among HIV–HCV co-infected persons during the IFN (2003–2011) and second-generation DAA (2013–2020) eras. Methods We used data from the Canadian Co-infection Cohort, a multicentre prospective cohort, and its associated sub-study on Food Security (FS). We predicted Center for Epidemiologic Studies Depression Scale-10 (CES-D-10) classes for depressive symptoms indicative of a depression risk using a random forest classifier and corrected for misclassification using predictive value-based record-level correction. We used marginal structural Cox proportional hazards models with inverse weighting for competing risks (death) to assess the effect of depressive symptoms on treatment initiation among HCV RNA-positive participants. Results We included 590 and 1127 participants in the IFN and DAA eras. The treatment initiation rate increased from 9 (95% confidence interval (CI): 7–10) to 21 (95% CI: 19–22) per 100 person-years from the IFN to DAA era. Treatment initiation was lower among those with depressive symptoms compared to those without in the IFN era (hazard ratio: 0.81 (95% CI: 0.69–0.95)) and was higher in the DAA era (1.19 (95% CI: 1.10–1.27)). Conclusion Depressive symptoms no longer appear to be a barrier to HCV treatment initiation in the co-infected population in the DAA era. The higher rate of treatment initiation in individuals with depressive symptoms suggests those previously unable to tolerate IFN are now accessing treatment.

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Trends in cause-specific mortality in HIV–hepatitis C coinfection following hepatitis C treatment scale-up

Abstract: Supplemental Digital Content is available in the text

Cited by 24 publications

References 38 publications

Using the barriers and facilitators to linkage to HIV care to inform hepatitis C virus (HCV) linkage to care strategies for people released from prison: Findings from a systematic review

Using the barriers and facilitators to linkage to HIV care to inform hepatitis C virus (HCV) linkage to care strategies for people released from prison: Findings from a systematic review

Impact of hepatitis C virus antibody positivity on mortality and causes of death in people living with HIV in Georgia

Depressive symptoms are no longer a barrier to HCV treatment initiation in the HIV–HCV co-infected population in Canada

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