scholarly journals Barriers to Hepatitis C Virus (HCV) Treatment Initiation in Patients With Human Immunodeficiency Virus/HCV Coinfection: Lessons From the Interferon Era

2017 ◽  
Vol 4 (1) ◽  
Author(s):  
Tanyaporn Wansom ◽  
Oluwaseun Falade-Nwulia ◽  
Catherine G. Sutcliffe ◽  
Shruti H. Mehta ◽  
Richard D. Moore ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Treatment Initiation ◽  
Incidence Density ◽  
Hcv Treatment ◽  
Major Barrier ◽  
Treatment Uptake ◽  
Immunodeficiency Virus ◽  
Missed Visits

Abstract Background Hepatitis C is a major cause of mortality among human immunodeficiency virus (HIV)-infected patients, yet hepatitis C virus (HCV) treatment uptake has historically been low. Although the removal of interferon removes a major barrier to HCV treatment uptake, oral therapies alone may not fully eliminate barriers in this population. Methods Within the Johns Hopkins Hospital HIV cohort, a nested case-control study was conducted to identify cases, defined as patients initiating HCV treatment between January 1996 and 2013, and controls, which were selected using incidence density sampling (3:1 ratio). Controls were matched to cases on date of enrollment. Conditional logistic regression was used to evaluate factors associated with HCV treatment initiation. Results Among 208 treated cases and 624 untreated controls, the presence of advanced fibrosis (odds ratio [OR], 2.23; 95% confidence interval [CI], 1.26–3.95), recent active drug use (OR, 0.36; 95% CI, 0.19–0.69), and non-black race (OR, 2.01; 95% CI, 1.26–3.20) were independently associated with initiation of HCV therapy. An increasing proportion of missed visits was also independently associated with lower odds of HCV treatment (25%–49% missed visits [OR, 0.49; 95% CI, 0.27–0.91] and ≥50% missed visits [OR, 0.24; 95% CI, 0.12–0.48]). Conclusions Interferon-free treatments may not be sufficient to fully overcome barriers to HCV care in HIV-infected patients. Interventions to increase engagement in care for HIV and substance use are needed to expand HCV treatment uptake.

scholarly journals Hepatitis C treatment uptake and response among human immunodeficiency virus/hepatitis C virus-coinfected patients in a large integrated healthcare system

2019 ◽  
Vol 30 (7) ◽  
pp. 689-695 ◽  
Author(s):  
Jennifer O Lam ◽  
Leo B Hurley ◽  
Scott Chamberland ◽  
Jamila H Champsi ◽  
Laura C Gittleman ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Drug Abuse ◽  
Cell Count ◽  
Hcv Treatment ◽  
Cd4 Cell Count ◽  
Treatment Uptake ◽  
Immunodeficiency Virus ◽  
Cd4 Cell

U.S. guidelines recommend that patients coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) be prioritized for HCV treatment with direct-acting antiviral agents (DAAs), but the high cost of DAAs may contribute to disparities in treatment uptake and outcomes. We evaluated DAA initiation and effectiveness in HIV/HCV-coinfected patients in a U.S.-based healthcare system during October 2014–December 2017. Of 462 HIV/HCV-coinfected patients, 276 initiated DAAs (70% cumulative proportion treated over three years). Lower likelihood of DAA initiation was observed among patients with Medicare (government-sponsored insurance) versus commercial insurance (adjusted rate ratio [aRR] = 0.62, 95% CI = 0.46–0.84), patients with drug abuse diagnoses (aRR = 0.72, 95% CI = 0.54–0.97), patients with CD4 cell count <200 cells/µl versus ≥500 (aRR = 0.45, 95% CI = 0.23–0.91), and patients without prior HCV treatment (aRR = 0.68, 95% CI = 0.48–0.97). There were no significant differences in DAA initiation by age, gender, race/ethnicity, socioeconomic status, HIV transmission risk, alcohol use, smoking, fibrosis level, HIV RNA levels, antiretroviral therapy use, hepatitis B infection, or number of outpatient visits. Ninety-five percent of patients achieved sustained virologic response (SVR). We found little evidence of sociodemographic disparities in DAA initiation among HIV/HCV-coinfected patients, and SVR rates were high. Efforts are needed to increase DAA uptake among coinfected Medicare enrollees, patients with drug abuse diagnoses, patients with low CD4 cell count, and patients receiving first-time HCV treatment.

scholarly journals Eliminating Structural Barriers: The Impact of Unrestricted Access on Hepatitis C Treatment Uptake Among People Living With Human Immunodeficiency Virus

2019 ◽  
Vol 71 (2) ◽  
pp. 363-371 ◽  
Author(s):  
Sahar Saeed ◽  
Erin Strumpf ◽  
Erica E M Moodie ◽  
Leo Wong ◽  
Joseph Cox ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hepatitis C ◽  
Treatment Initiation ◽  
Fibrosis Stage ◽  
World Health ◽  
Structural Barriers ◽  
Hcv Treatment ◽  
Treatment Uptake ◽  
Immunodeficiency Virus ◽  
The Impact

Abstract Background High costs of direct-acting antivirals (DAAs) have led health-care insurers to limit access worldwide. Using a natural experiment, we evaluated the impact of removing fibrosis stage restrictions on hepatitis C (HCV) treatment initiation rates among people living with human immunodeficiency virus (HIV), and then examined who was left to be treated. Methods Using data from the Canadian HIV-HCV Coinfection Cohort, we applied a difference-in-differences approach. Changes in treatment initiation rates following the removal of fibrosis stage restrictions were assessed using a negative binomial regression with generalized estimating equations. The policy change was then specifically assessed among people who inject drugs (PWID). We then identified the characteristics of participants who remained to be treated using a modified Poisson regression. Results Between 2010–2018, there were a total of 585 HCV initiations among 1130 eligible participants. After removing fibrosis stage restrictions, DAA initiations increased by 1.8-fold (95% confidence interval [CI] 1.3–2.4) controlling for time-invariant differences and secular trends. Among PWID the impact appeared even stronger, with an adjusted incidence rate ratio of 3.6 (95% CI 1.8–7.4). However, this increased treatment uptake was not sustained. At 1 year following universal access, treatment rates declined to 0.8 (95% CI .5–1.1). Marginalized participants (PWID and those of indigenous ethnicity) and those disengaged from care were more likely to remain HCV RNA positive. Conclusions After the removal of fibrosis restrictions, HCV treatment initiations nearly doubled immediately, but this treatment rate was not sustained. To meet the World Health Organization elimination targets, the minimization of structural barriers and adoption of tailored interventions are needed to engage and treat all vulnerable populations.

scholarly journals Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) Dynamics during HCV Treatment in HCV/HIV Coinfection

2003 ◽  
Vol 188 (10) ◽  
pp. 1498-1507 ◽  
Author(s):  
Francesca J. Torriani ◽  
Ruy M. Ribeiro ◽  
Tari L. Gilbert ◽  
Uschi M. Schrenk ◽  
Marietta Clauson ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Hcv Treatment ◽  
Hiv Dynamics ◽  
Hiv Coinfection ◽  
Immunodeficiency Virus

scholarly journals Estimating the Time to Diagnosis and the Chance of Spontaneous Clearance During Acute Hepatitis C in Human Immunodeficiency Virus-Infected Individuals

2017 ◽  
Vol 4 (1) ◽  
Author(s):  
Romain Ragonnet ◽  
Sylvie Deuffic-Burban ◽  
Christoph Boesecke ◽  
Marguerite Guiguet ◽  
Karine Lacombe ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Acute Hepatitis ◽  
Treatment Initiation ◽  
Spontaneous Clearance ◽  
Acute Hepatitis C ◽  
Immunodeficiency Virus ◽  
Hcv Transmission ◽  
Wait And See

Abstract Background Hepatitis C virus (HCV) infection is often asymptomatic, and the date of infection is almost impossible to determine. Furthermore, spontaneous clearance (SC) may occur, but little is known about its time of occurrence. Methods Data on human immunodeficiency virus (HIV)-HCV coinfected individuals were used to inform a stochastic simulation model of HCV viral load kinetics, alanine aminotransferase (ALT), and HCV antibodies during acute hepatitis C. The dates of diagnosis and potential SC were estimated through a Bayesian approach. Hepatitis C virus diagnosis was assumed to be based on an elevated ALT level detected during a control visit for HIV-infected individuals, which occurred every 3 months (scenario A) or every 6 months (scenario B). Results We found that HCV diagnosis occurred after a median of 115 days and 170 days of infection in scenarios A and B, respectively. Among spontaneous clearers, SC occurred after a median time of 184 days after infection. Seven percent (scenario B) to 10% (scenario A) of SCs appeared more than 6 months after diagnosis, and 3% (both scenarios) of SCs appeared more than 1 year after diagnosis. Conclusions Acute hepatitis C diagnosis occurs late in HIV-HCV coinfected individuals. Screening for HCV in HIV-infected individuals should be performed frequently to reduce delays. Our findings about late occurrence of SC support “wait and see” strategies for treatment initiation from an individual basis. However, early treatment initiation may reduce HCV transmission.

scholarly journals CD4 T Lymphocyte Proliferative Responses to Hepatitis C Virus (HCV) Antigens in Patients Coinfected with HCV and Human Immunodeficiency Virus Who Responded to Anti‐HCV Treatment

2002 ◽  
Vol 186 (3) ◽  
pp. 302-311 ◽  
Author(s):  
Elisabeth Legrand ◽  
Didier Neau ◽  
Tatiana Galperine ◽  
Pascale Trimoulet ◽  
Jean‐François Moreau ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
T Lymphocyte ◽  
Hcv Treatment ◽  
Immunodeficiency Virus

IL28RA polymorphism is associated with early hepatitis C virus (HCV) treatment failure in human immunodeficiency virus-/HCV-coinfected patients

2012 ◽  
Vol 20 (5) ◽  
pp. 358-366 ◽  
Author(s):  
M. A. Jiménez-Sousa ◽  
J. Berenguer ◽  
N. Rallón ◽  
M. Guzmán-Fulgencio ◽  
J. C. López ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Treatment Failure ◽  
Hcv Treatment ◽  
Immunodeficiency Virus

scholarly journals The Effect of Hepatitis C Virologic Clearance on Cardiovascular Disease Biomarkers in Human Immunodeficiency Virus/Hepatitis C Virus Coinfection

2014 ◽  
Vol 1 (3) ◽  
Author(s):  
Kara W. Chew ◽  
Lei Hua ◽  
Debika Bhattacharya ◽  
Adeel A. Butt ◽  
Lorelei Bornfleth ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Human Immunodeficiency Virus ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Sustained Virologic Response ◽  
Virologic Response ◽  
Hcv Treatment ◽  
Cvd Risk ◽  
Activation Markers ◽  
Immunodeficiency Virus

Abstract Background.  Successful hepatitis C virus (HCV) treatment may reduce cardiovascular disease (CVD) risk and improve levels of CVD biomarkers produced outside the liver (nonhepatic biomarkers). Methods.  Stored serum or plasma from before and 24 weeks after end of HCV treatment (EOT) from human immunodeficiency virus (HIV)/HCV-coinfected subjects who received up to 72 weeks of peginterferon/ribavirin, 27 with and 27 without sustained virologic response (SVR) matched by race, ethnicity and sex, were tested for nonhepatic (soluble intercellular adhesion molecule-1 [sICAM-1], soluble P-selectin [sP-selectin], interleukin [IL]-6, d-dimer, and lipoprotein-associated phospholipase A2 [Lp-PLA2]) and hepatic (cholesterol and high-sensitivity C-reactive protein) CVD and macrophage activation markers (soluble CD163 [sCD163] and soluble CD14). Changes in biomarkers and their association with SVR were examined by t tests or Wilcoxon tests and regression models. Results.  Of the 54 subjects, 30 were white, 24 were black, and 44 were male. Pretreatment levels of nonhepatic biomarkers were high: sICAM-1 overall median, 439.2 ng/mL (interquartile range [IQR], 365.6–592.8]; sP-selectin, 146.7 ng/mL (IQR, 94.1–209.9), and IL-6, 2.32 pg/mL (IQR, 1.61–3.49). Thirty-seven of 52 (71%) subjects had Lp-PLA2 &gt;235 ng/mL. Sustained virologic response was associated with decrease in sICAM-1 (P = .033) and sCD163 (P = .042); this result was attenuated after controlling for changes in the alanine aminotransferase level. At 24 weeks after EOT, 17 (63%) SVRs had Lp-PLA2 &gt;235 ng/mL vs 25 (93%) non-SVRs (P = .021). Conclusions.  Hepatitis C virus clearance may reduce hepatic and, subsequently, systemic inflammation and CVD risk in HIV/HCV coinfection.

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