Abstract
BackgroundThe aims were to investigate the hepatitis C (HCV) cascade of care among HIV-infected patients and to identify reasons for not referring for and not initiating HCV therapy after completion of HCV treatment staging.Design and MethodsRetrospective cohort analysis of HIV-infected patients under care at the University of California, San Diego (UCSD). We identified patients screened for and diagnosed with active HCV infection. Logistic regression analyses were used to identify factors associated with lack of referral for HCV therapy. Electronic medical records were reviewed to ascertain reasons for not initiating HCV therapy.ResultsBetween 2008 and 2012, 4725 HIV-infected patients received care at the UCSD Owen clinic. Most patients [4534 (96%)] were screened for HCV, 748 (16%) patients had reactive serum HCV antibodies but only 542 patients had active HCV infection. Lack of engagement in care was the most important predictor of non-referral for HCV therapy [odds ratio (OR): 5.08, 95% confidence interval 3.24–6.97, p<0.00001]. Other significant predictors included unstable housing (OR: 2.26), AIDS (OR: 1.83), having a detectable HIV viral load (OR: 1.98) and being non-white (OR: 1.67). The most common reason (40%) for not initiating or deferring HCV therapy was the presence of ongoing barriers to care.ConclusionsScreening for HCV in HIV-infected patients linked to care is high but almost half of patients diagnosed with HCV are not referred for HCV therapy. Despite improvements in HCV therapy the benefits will not be realized unless effective measures for dealing with barriers to care are implemented.
Highlights
25% of persons living with human immunodeficiency virus (HIV) infection are coinfected with hepatitis C (HCV) [1]
Screening for HCV in HIV-infected patients linked to care is high but almost half of patients diagnosed with HCV are not referred for HCV therapy
In 2008, a multidisciplinary HCV coinfection primary care-based program was implemented at UCSD, with an inclusive protocol aimed at increasing HCV treatment uptake among HIV coinfected patients, including those with ongoing drug and/or alcohol abuse and neuropsychiatric disease [11]
Summary
25% of persons living with human immunodeficiency virus (HIV) infection are coinfected with hepatitis C (HCV) [1]. Guidelines recommend screening for HCV in persons infected with HIV upon establishment of care [2]. In a large diverse cohort of HIV clinics across the United States at the end of 2011, 85% of HIV-infected persons received HCV antibody screening within 3-months of enrolling in care [3]. Despite the high prevalence of HCV among HIV-infected persons and major advances in HCV therapy, access to HCV treatment remains low in this population across the United States and Europe [4,5]. There is an urgent need to increase both access to treatment and treatment uptake of HCV in HIV-infected persons. The aims were to investigate the hepatitis C (HCV) cascade of care among HIV-infected patients and to identify reasons for not referring for and not initiating HCV therapy after completion of HCV treatment staging
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