Abstract
BackgroundTreatment for the hepatitis C virus (HCV) may be delayed significantly in HIV/HCV co-infected patients. Our study aims at identifying the correlates of access to HCV treatment in this population.MethodsWe used 3-year follow-up data from the HEPAVIH ANRS-CO13 nationwide French cohort which enrolled patients living with HIV and HCV. We included pegylated interferon and ribavirin-naive patients (N = 600) at enrolment. Clinical/biological data were retrieved from medical records. Self-administered questionnaires were used for both physicians and their patients to collect data about experience and behaviors, respectively.ResultsMedian [IQR] follow-up was 12[12-24] months and 124 patients (20.7%) had started HCV treatment. After multiple adjustment including patients' negative beliefs about HCV treatment, those followed up by a general practitioner working in a hospital setting were more likely to receive HCV treatment (OR[95%CI]: 1.71 [1.06-2.75]). Patients followed by general practitioners also reported significantly higher levels of alcohol use, severe depressive symptoms and poor social conditions than those followed up by other physicians.ConclusionsHospital-general practitioner networks can play a crucial role in engaging patients who are the most vulnerable and in reducing existing inequities in access to HCV care. Further operational research is needed to assess to what extent these models can be implemented in other settings and for patients who bear the burden of multiple co-morbidities.
Highlights
Treatment for the hepatitis C virus (HCV) may be delayed significantly in HIV/HCV co-infected patients
The following patients were not included in analyses: individuals with decompensated cirrhosis (N = 14), those who had undergone a liver transplantation (N = 1) or who had hepatocellular carcinoma (N = 2) and those who had not completed any part of the self-administered questionnaire at enrolment (N = 162)
No significant differences were found in terms of gender, age, CD4, HIV viral load and HCV viral load, ASAT, ALAT, HCV genotype and fibrosis at baseline, whether follow-up by a general practitioner or not, between those who filled in the self-administered questionnaires (N = 600) and those who did not (N = 162)
Summary
Treatment for the hepatitis C virus (HCV) may be delayed significantly in HIV/HCV co-infected patients. Treatment for HCV is available and cost-effective [6]; it cures 45% of patients with HCV genotype 1 infection obtained from clinic-based cohorts where rates range from 3% to 28% [12,20,21,22,23]. Patient characteristics, such as age, genotype, hepatic dysfunction, substance abuse, mental health issues and perception about treatment effectiveness and side effects [17,24] are important predictors of HCV treatment initiation. In HIV-HCV co-infected patients, HCV treatment uptake rates are usually lower than 50% and vary across the different regions of Europe [28,29]. In France, one cross-sectional study showed that 46% of HIV-HCV co-infected patients followed up in specialized centers for HIV care had received HCV treatment in 2004 [30] while other studies confirmed that barriers are found when engaging HIV-HCV co-infected individuals in HCV care [31,32]
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