Factors associated with guideline-based hepatitis C virus (HCV) treatment initiation in HIV/HCV-coinfected patients: role of comorbidities and physicians' perceptions
M Winnock, F Bani-Sadr, E Pambrun, M-A Loko, P Carrieri, D Neau, P Morlat, B Marchou, F Dabis, D Salmon, French National Agency for Research on AIDS and Viral Hepatitis (ANRS) CO13 HEPAVIH Study Group, M Winnock, F Bani-Sadr, E Pambrun, M-A Loko, P Carrieri, D Neau, P Morlat, B Marchou, F Dabis, D Salmon, French National Agency for Research on AIDS and Viral Hepatitis (ANRS) CO13 HEPAVIH Study Group
Abstract
Objectives: Many HIV-infected patients with chronic hepatitis C virus (HCV) infection do not receive treatment for HCV infection, often because of contraindications or poor adherence to anti-HIV therapy. The aim of this study was to identify factors influencing guideline-based HCV treatment initiation in a large cohort of HIV/HCV-coinfected patients.
Methods: Between 2005 and 2011, 194 (40.5%) of 479 coinfected patients not previously treated for HCV infection started this treatment based on current recommendations, i.e. a Metavir score >F1 for liver fibrosis; HCV genotype 2 or 3 infection; or HCV genotype 1 or 4 infection and low HCV viral load (<800000 IU/mL), whatever the fibrosis score. Clinical and biological data were compared between patients who started HCV therapy during follow-up and those who did not.
Results: In multivariate analyses, good adherence to treatment for HIV infection, as judged by the patient's physician, was associated with HCV treatment initiation [odds ratio (OR) 2.37; 95% confidence interval (CI) 1.17-4.81; P=0.017], whereas patients with children (OR 0.53; 95% CI 0.30-0.91; P=0.022) and those with cardiovascular disease or respiratory distress (OR 0.10; 95% CI 0.01-0.78; P=0.03) were less likely to be treated.
Conclusions: Adherence to treatment for HIV infection, as judged by the patient's physician, appears to have a major influence on the decision to begin treatment for HCV infection in coinfected patients. This calls for specific therapeutic education and adherence support in order to ensure timely anti-HCV therapy in this population.
Keywords: HCV treatment adherence; HIV treatment adherence; HIV/HCV coinfection.
© 2013 British HIV Association.
Source: PubMed