Increasing Hepatitis C treatment uptake among HIV-infected patients using an HIV primary care model

Edward R Cachay, Lucas Hill, Craig Ballard, Bradford Colwell, Francesca Torriani, David Wyles, William C Mathews, Edward R Cachay, Lucas Hill, Craig Ballard, Bradford Colwell, Francesca Torriani, David Wyles, William C Mathews

Abstract

Background: Access to Hepatitis C (HCV) care is low among HIV-infected individuals, highlighting the need for new models to deliver care for this population.

Methods: Retrospective cohort analysis that compared the number of HIV patients who initiated HCV therapy: hepatology (2005-2008) vs. HIV primary care model (2008-2011). Logistic-regression modeling was used to ascertain factors associated with HCV therapy initiation and achievement of sustained viral response (SVR).

Results: Of 196 and 163 patients that were enrolled in the HIV primary care and hepatology models, 48 and 26 were treated for HCV, respectively (p = 0.043). The HIV/HCV-patient referral rate did not differ during the two study periods (0.10 vs. 0.12/patient-yr, p = 0.18). In unadjusted analysis, predictors (p < 0.05) of HCV treatment initiation included referral to the HIV primary care model (OR: 1.7), a CD4+ count ≥400/mm3 (OR: 1.8) and alanine aminotranferase level ≥63U/L (OR: 1.9). Prior psychiatric medication use correlated negatively with HCV treatment initiation (OR: 0.6, p = 0.045). In adjusted analysis the strongest predictor of HCV treatment initiation was CD4+ count (≥400/mm3, OR: 2.1, p = 0.01). There was no significant difference in either clinic model (primary care vs. hepatology) in the rates of treatment discontinuation due to adverse events (29% vs. 16%), loss to follow-up (8 vs. 8%), or HCV SVR (44 vs. 35%).

Conclusions: Using a HIV primary care model increased the number of HIV patients who initiate HCV therapy with comparable outcomes to a hepatology model.

Figures

Figure 1
Figure 1
Flow of included patients.

References

    1. Scott JD, Wald A, Kitahata M. Hepatitis C virus is infrequently evaluated and treated in an urban HIV clinic population. AIDS Patient Care STDS. 2009;23:925–929. doi: 10.1089/apc.2009.0099.
    1. Vellozzi C, Buchacz K, Baker R. Treatment of hepatitis C virus (HCV) infection in patients coinfected with HIV in the HIV Outpatient Study (HOPS), 1999–2007. J Viral Hepat. 2011;18:316–324. doi: 10.1111/j.1365-2893.2010.01299.x.
    1. Reiberger T, Obermeier M, Payer BA. Considerable under-treatment of chronic HCV infection in HIV patients despite acceptable sustained virological response rates in a real-life setting. Antivir Ther. 2011;16:815–824. doi: 10.3851/IMP1831.
    1. Gordon S, Pockros P, Terrault N. Impact of disease severity on health care costs in patients with chronic hepatitis C (CHC) virus infection. Hepatology. 2012;56:1651–1660. doi: 10.1002/hep.25842.
    1. Norton BL, Park L, McGrath LJ, Proeschold Bell RJ, Muir AJ, Naggie S. Health care utilization in HIV-infected patients: assessing the burden of hepatitis C virus coinfection. AIDS Patient Care STDS. 2012;26:541–545. doi: 10.1089/apc.2012.0170.
    1. Goulet JL, Fultz SL, McGinnis KA, Justice AC. Relative prevalence of comorbidities and treatment contraindications in HIV-mono-infected and HIV/HCV-co-infected veterans. AIDS. 2005;19(Suppl 3):S99–S105. doi: 10.1097/01.aids.0000192077.11067.e5.
    1. Golden J, O'Dwyer AM, Conroy RM. Depression and anxiety in patients with hepatitis C: prevalence, detection rates and risk factors. Gen Hosp Psychiatry. 2005;27:431–438. doi: 10.1016/j.genhosppsych.2005.06.006.
    1. Fleming CA, Tumilty S, Murray JE, Nunes D. Challenges in the treatment of patients coinfected with HIV and hepatitis C virus: need for team care. Clin Infect Dis. 2005;40(Suppl 5):S349–S354.
    1. Lekas HM, Siegel K, Leider J. Challenges facing providers caring for HIV/HCV-coinfected patients. Qual Health Res. 2012;22:54–66. doi: 10.1177/1049732311418248.
    1. Astell-Burt T, Flowerdew R, Boyle P, Dillon J. Is travel-time to a specialist centre a risk factor for non-referral, non-attendance and loss to follow-up among patients with hepatitis C (HCV) infection? Soc Sci Med. 2012;75:240–247. doi: 10.1016/j.socscimed.2012.02.046.
    1. Preau M, Protopopescu C, Raffi F. Satisfaction with care in HIV-infected patients treated with long-term follow-up antiretroviral therapy: the role of social vulnerability. AIDS Care. 2012;24:434–443.
    1. Ghany MG, Strader DB, Thomas DL, Seff LB. Diagnosis, management and treatment of hepatitis C: un update. Hepatology. 2009;49:1335–1374. doi: 10.1002/hep.22759.
    1. WHO ASSIST Working Group. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): development, reliability and feasibility. Addiction. 2002;97:1183–1194. doi: 10.1046/j.1360-0443.2002.00185.x.
    1. Curcio F, Di Martino F, Capraro C. Together … to take care: multidisciplinary management of hepatitis C virus treatment in randomly selected drug users with chronic hepatitis. J Addict Med. 2010;4:223–232. doi: 10.1097/ADM.0b013e3181cae4d0.
    1. Ford N, Singh K, Cooke GS. Expanding access to treatment for hepatitis C in resource-limited settings: lessons from HIV/AIDS. Clin Infect Dis. 2012;54:1465–1472. doi: 10.1093/cid/cis227.
    1. Kieran J, Dillon A, Farrell G. High uptake of hepatitis C virus treatment in HIV/hepatitis C virus co-infected patients attending an integrated HIV/hepatitis C virus clinic. Int J STD AIDS. 2011;22:571–576. doi: 10.1258/ijsa.2011.010416.
    1. Parry J. HIV groups have much to teach hepatitis doctors about better diagnosis and treatment. BMJ. 2012;344:e1266. doi: 10.1136/bmj.e1266.
    1. Ingiliz P, Rockstroh JK. HIV-HCV co-infection facing HCV protease inhibitor licensing: implications for clinicians. Liver Int. 2012;32:1194–1199. doi: 10.1111/j.1478-3231.2012.02796.x.
    1. Cachay ER, Wyles DL, Goicoechea M. Reliability and predictive validity of a hepatitis-related symptom inventory in HIV-infected individuals referred for hepatitis C treatment. AIDS Res Ther. 2011;8:e29. doi: 10.1186/1742-6405-8-29.
    1. Ge D, Fellay J, Thompson AJ, Simon JS, Shianna KV, Urban TJ, Heinzen EL, Qiu P, Bertelsen AH, Muir AJ, Sulkowski M, McHutchison JG, Goldstein DB. Genetic variation in IL28B predicts hepatitis C treatment-induced viral clearance. Nature. 2009;461:399–401. doi: 10.1038/nature08309.
    1. Morse DS, Schiff M, Levit S, Cohen-Moreno R, Williams GC, Neumark Y. A pilot training program for a motivational enhancement approach to hepatitis C virus treatment among individuals in Israeli methadone treatment centers. Subst Use Misuse. 2012;47:56–66. doi: 10.3109/10826084.2011.628735.
    1. Joshi D, O'Grady J, Dieterich D, Gazzard B, Agarwal K. Increasing burden of liver disease in patients with HIV infection. Lancet. 2011;377:1198–1209. doi: 10.1016/S0140-6736(10)62001-6.
    1. Moak ZSD, Osinusi A, Silk R, Kotb C. Community engagement in a unique federal-local partnership: A model for hepatitits care and research [Abstract WEPE051] Program and abstracts of the19th International AIDS Conference July 22–27. Washington DC, USA. 2012.
    1. Grint D, Peters L, Vogel M, Beniowski M, Pradier C, Battegay M, Jevtovic D, Soriano V, Lundgren J, Rockstroh J, Kirk O, Mocroft A. Temporal changes and regional differences in treatment uptake of hepatitis C therapy in EuroSIDA [Abstract 0243] Posters and abstracts of the Eleventh International Congress on Drug Therapy in HIV Infection, Glasgow. 2012.
    1. Rourke SB, Sobota M, Tucker R. Social determinants of health associated with hepatitis C co-infection among people living with HIV: results from the Positive Spaces, Healthy Places study. Open Med. 2011;5:e120–e131.
    1. McHutchison JG, Everson GT, Gordon SC. Telaprevir with peginterferon and ribavirin for chronic HCV genotype 1 infection. N Engl J Med. 2009;360:1827–1838. doi: 10.1056/NEJMoa0806104.
    1. Poordad F, McCone J Jr, Bacon BR. Boceprevir for untreated chronic HCV genotype 1 infection. N Engl J Med. 2011;364:1195–1206. doi: 10.1056/NEJMoa1010494.
    1. Lambert SM, Page AN, Wittmann J. General practitioner attitudes to prescribing hepatitis C antiviral therapy in a community setting. Aust J Prim Health. 2011;17:282–287. doi: 10.1071/PY10069.
    1. Hall CS, Charlebois ED, Hahn JA, Moss AR, Bangsberg DR. Hepatitis C virus infection in San Francisco's HIV-infected urban poor. J Gen Intern Med. 2004;19:357–365. doi: 10.1111/j.1525-1497.2004.30613.x.
    1. Poveda E, Vispo E, Barreiro P, de Mendoza C, Labarga P, Fernández-Montero JV, Martin-Carbonero L, Soriano V. Predicted effect of direct acting antivirals in the current HIV-HCV-coinfected population in Spain. Antivir Ther. 2012;17:571–575.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅