Received HCV Treatment Research Articles

Care of hepatitis C virus infection in human immunodeficiency virus-infected patients: Modifications in three consecutive large surveys between 2004 and 2009

To analyze the care of HCV infection in HIV-HCV coinfected patients and its progression between 2004 and 2009. Three hundred eighty HIV-HCV coinfected patients were prospectively included from November 22 to 29, 2004 (2004 survey), 416 patients from April 3 to 10, 2006 (2006 survey), and 419 patients from June 15 to 22, 2009 (2009 survey). The rate of liver biopsy decreased (14% vs. 38% vs. 56%), while the use of non-invasive liver damage tests increased (47% vs. 24% vs. ND) in the 2009, 2006, and 2004 surveys, respectively. The rate of patients that had never been treated for HCV infection progressively decreased in the 2009, 2006, and 2004 surveys (37%, 42%, and 54%). The main reasons for HCV non-treatment changed as HCV treatment was deemed less questionable and the lack of liver biopsy became a very rare reason (6%, 18%, and 34%). Among patients treated for HCV infection, the rate of sustained virological response increased (49%, 29%, and 29%). The main factors independently associated with HCV treatment were a liver fibrosis score > or =F2 (odds ratio=3.5; 95% CI 2.1-5.7), a liver biopsy activity grade > or =A2 (2.7; 1.4-5.3), a CD4 cell count > or =350 ml (2.7; 1.6-4.4), European origin (2.1; 1.3-3.4), daily alcohol consumption<30 g (2.1; 1.2-3.8), and male gender (2.0; 1.2-3.3). Compared to the 2004 and 2006 surveys, the 2009 coinfected patients had liver damage assessment more frequently, more patients had received HCV treatment and more patients had achieved a sustained virological response.

Treat early or wait and monitor? A qualitative analysis of provider hepatitis C virus treatment decision-making in the context of HIV coinfection.

Liver disease is a leading cause of death among patients with HIV coinfected with hepatitis C (HCV); yet, studies show that less than 10% receive HCV treatment, in part because of limited treatment response, high treatment toxicity, and psychosocial barriers to treatment readiness. Using a process model framework, we sought to explore the factors and processes by which providers make HCV treatment decisions for HIV-coinfected patients. We conducted 22 semistructured interviews with primary care providers and support staff at three HIV clinics in Los Angeles, California, in which rates of HCV treatment uptake varied from 10% to 38%. Providers agreed that stable HIV disease, favorable genotype, and significant signs of liver disease progression are all signs of need for treatment. However, two divergent treatment approaches emerged for genotype 1 and 4 patients with minimal disease, and in definitions of patient readiness. Providers with lower treatment rates preferred to delay treatment in hopes of better future treatment options, and were more conservative in requiring complete mental health screens and treatment and abstinence from substance use. Conversely, providers with higher treatment rates viewed all patients as needing treatment as soon as possible, and defined readiness more leniently, with some willing to treat even in the context of untreated depression and drug use, so long as ability to adhere well was demonstrated. Regardless of whether an aggressive or cautious approach to treatment is used, development of effective programs for promoting patient treatment readiness is critical to ensuring greater treatment uptake.

Factors That Influence an HIV Coinfected Patient's Decision to Start Hepatitis C Treatment

Liver disease is a leading cause of morbidity and mortality among patients coinfected with HIV and hepatitis C (HCV), yet few HIV coinfected patients actually receive HCV treatment. Providers must first be willing to prescribe treatment, but the patient ultimately makes the decision to accept or decline a treatment recommendation. We used a process model framework to explore the factors influencing patients' treatment decision-making. We conducted semistructured interviews with 35 HIV coinfected patients and 11 primary care providers at three HIV clinics in Los Angeles, California. Patients reported that stability of HIV disease, perceived need for HCV treatment, treatment readiness, willingness to deal with side effects, absence of substance abuse, and stability of mental health and overall life circumstances are key factors influencing treatment decision-making. Patients also spoke of the influence of the trusting relationship that many had with their provider, and providers acknowledged an awareness of the influence of how they present the risks and benefits of HCV treatment and the overall tone of their recommendation (encouraging, dissuasive, or neutral). These results speak to a social decision-making process between the patient and provider-a partnership that involves sequential interactions whereby both the patient and provider may influence the other's evaluation of the patient's readiness for treatment, with treatment initiation dependent on both agreeing on the need for treatment and the patient's readiness for treatment.

Barriers associated with the treatment of hepatitis C virus infection among illicit drug users

Background Illicit drug users account for the majority of cases of HCV infection in the developed world, but few have received treatment. Methods We evaluated barriers to initiating HCV treatment – including general treatment willingness – and factors associated with these among HCV infected illicit drug users. Participants were recruited via convenience sampling from two community clinics in Canada. Individuals age >18 years with a history of illicit drug use completed interviewer-administered surveys. Those reporting positive HCV testing underwent additional questioning on willingness, uptake and barriers to treatment for HCV. Results Of 188 HCV positive illicit drug users, 16% ( n = 30) had received treatment for HCV. Factors associated with a decreased treatment uptake included current heroin use and HIV/HCV co-infection. Among those not having received therapy, 77% (117/153) indicated a willingness to receive HCV treatment. Factors associated with treatment willingness included not being infected with HIV, having not recently used drugs by injection and having reported physical health problems. Among those not having sought HCV treatment ( n = 107), the major reasons for not doing so were: lack of information about HCV or knowledge that treatment was available (23%), the absence of symptoms (20%) and the perceived side effects of treatment (14%). Conclusions Among illicit drug users attending inner city clinics, we have observed a low uptake of HCV treatment, but a high willingness to receive therapy. An increased focus on improving education about the long-term consequences of HCV and the availability of effective treatment are important components for expanding HCV treatment among illicit drug users.

A prospective study to examine persistent HCV reinfection in injection drug users who have previously cleared the virus

Background Many HCV-infected persons with recent or ongoing injection drug use (IDU) do not receive HCV treatment due to the perceived risk of HCV reinfection. There are few prospective studies investigating HCV reinfection among IDUs. Methods Two hundred and twenty-four persons with past or ongoing IDU were followed from 1997 to 2007. Baseline and every 6-month follow-up data were collected including demographics, IDU, and sexual behaviors. Serum was tested for the presence of HCV antibody and serially for HCV RNA. Resolvers were defined as HCV antibody and RIBA positive and RNA negative at two consecutive time points or as becoming HCV RNA negative after HCV antiviral treatment. Reinfection was defined by the presence of HCV RNA at ≥2 visits. Results One hundred and eighty-six persons had chronic HCV and 38 had resolved HCV. The resolvers were followed for a total of 214 person-years. Forty-two percent of resolvers reported ongoing IDU, representing 58 person-years of IDU. Only one reinfection occurred in the resolvers, for a reinfection rate of 0.47 cases/100 person-years of follow-up. The single reinfection, which occurred in a person who continued to inject drugs, represents a reinfection rate of 1.75 cases/100 person-years of IDU. Conclusion These data suggest that despite ongoing IDU, persistent HCV reinfection is lower than previously published. This can be attributed to a more clinically relevant definition of reinfection. This information will better help clinicians make informed decisions regarding HCV treatment options for patients who may continue to inject illicit drugs.

Psychiatric patients not receiving HCV treatment

Psychiatric patients not receiving HCV treatment

Acceptabilité d’un traitement du virus de l’hépatite C chez des utilisateurs de drogues injectables au Canada

The majority of prevalent and incident hepatitis C (HCV) infections in Canada are related to injection drug use (IDU), thus positioning injection drug users (IDUs) as a critical population to be targeted for HCV treatment. Little research has been undertaken in order to discover the willingness of IDUs to receive HCV treatment, however.The study sample was part of the Opican (illicit OPIoid use in CANada) cohort study of illicit opioid and other drug users in five Canadian cities.Data were collected from a sub-sample of 50 HCV-positive IDUs in Toronto. Four fifths of participants indicated general willingness to participate in HCV treatment. Two conditional treatment questions led to significant decreases in treatment willingness (potential treatment side effects and requirement of addiction treatment).The majority of IDUs in this sample indicated willingness to participate in HCV treatment, yet the particular needs and situations of this marginalized population have to be considered and addressed for responsive HCV treatment delivery.

Disturbingly low levels of contraception among women living with hepatitis C

Objective: To describe the prevalence of contraception among a sample of women with hepatitis C (HCV), compare it with contraceptive use among Australian women generally, and look for associations between contraception and sample characteristics.Method: Women who self‐identified as living with HCV were recruited through a wide range of non‐clinical and clinical sites in the Australian Capital Territory (ACT) and Victoria to complete a self‐administered questionnaire.Results: Seventy‐five per cent of distributed questionnaires were completed and returned. Of the 462 women surveyed, 34% of those aged 18–49 reported using contraceptives; a much lower prevalence than the 67% in the Australian population. Surprisingly, w omen who reported concerns about transmission to children were no more likely to use contraceptives. Not surprisingly, women who were lesbian or who did not have a current partner were even less likely to use contraceptives. Both employed women and those not on benefits reported significantly higher levels of contraception. Otherwise, contraception did not vary with a range of variables including age, education, injecting drug use status, self‐rated health status, experience of HCV symptoms, time since diagnosis, ever having received HCV treatment, or venue at which the participants were recruited.Conclusions: The low prevalence of contraception among women with HCV is both disturbing and puzzling.Implications: These findings raise several important and hitherto unconsidered issues for the sexual and reproductive health and well‐being of women with HCV. These require both fur ther research and urgent attention by service providers.