TY - JOUR
T1 - Barriers to Hepatitis C Virus (HCV) treatment initiation in patients with human immunodeficiency virus/HCV coinfection
T2 - Lessons From the interferon era
AU - Wansom, Tanyaporn
AU - Falade-Nwulia, Oluwaseun
AU - Sutcliffe, Catherine G.
AU - Mehta, Shruti H.
AU - Moore, Richard D.
AU - Thomas, David L.
AU - Sulkowski, Mark S.
N1 - Funding Information:
Financial support. This work was funded by the National Institutes of Health/National Institute on Drug Abuse Grants R01DA16065, R37DA013806, U01DA036935; Mid-career Mentor Award K24DA034621 (to M. S. S.); and National Institutes of Health/National Institute of Allergy and Infectious Diseases Grant P30 AI094189. D. L. T. was supported by National Institutes of Health/National Institute on Drug Abuse Grant DAR37013806, O. F.-N. was supported by National Institutes of Health/National Institute on Drug Abuse Grant K23DA041294, and T. W. was supported by Johns Hopkins Institute for Clinical and Translational Research (ICTR) Grant 1KL2TR001077 which is funded in part by Grant Number UL1 TR001079 from the National Center for Advancing Translational Sciences (NCATS) a component of the National Institutes of Health (NIH) and Bristol-Myers Squibb Virology Fellows Grant. M. S. S. reports grants and personal fees from AbbVie, personal fees from Cocrystal, grants and personal fees from Gilead, grants and personal fees from Janssen, grants and personal fees from Merck, personal fees from Trek, outside the submitted work.
Publisher Copyright:
© The Author 2017.
PY - 2017/11/1
Y1 - 2017/11/1
N2 - Background. Hepatitis C is a major cause of mortality among human immunodeficiency virus (HIV)-infected patients, yet hepatitis C virus (HCV) treatment uptake has historically been low. Although the removal of interferon removes a major barrier to HCV treatment uptake, oral therapies alone may not fully eliminate barriers in this population. Methods. Within the Johns Hopkins Hospital HIV cohort, a nested case-control study was conducted to identify cases, defined as patients initiating HCV treatment between January 1996 and 2013, and controls, which were selected using incidence density sampling (3:1 ratio). Controls were matched to cases on date of enrollment. Conditional logistic regression was used to evaluate factors associated with HCV treatment initiation. Results. Among 208 treated cases and 624 untreated controls, the presence of advanced fibrosis (odds ratio [OR], 2.23; 95% confidence interval [CI], 1.26-3.95), recent active drug use (OR, 0.36; 95% CI, 0.19-0.69), and non-black race (OR, 2.01; 95% CI, 1.26-3.20) were independently associated with initiation of HCV therapy. An increasing proportion of missed visits was also independently associated with lower odds of HCV treatment (25%-49% missed visits [OR, 0.49; 95% CI, 0.27-0.91] and ≥50% missed visits [OR, 0.24; 95% CI, 0.12-0.48]). Conclusions. Interferon-free treatments may not be sufficient to fully overcome barriers to HCV care in HIV-infected patients. Interventions to increase engagement in care for HIV and substance use are needed to expand HCV treatment uptake.
AB - Background. Hepatitis C is a major cause of mortality among human immunodeficiency virus (HIV)-infected patients, yet hepatitis C virus (HCV) treatment uptake has historically been low. Although the removal of interferon removes a major barrier to HCV treatment uptake, oral therapies alone may not fully eliminate barriers in this population. Methods. Within the Johns Hopkins Hospital HIV cohort, a nested case-control study was conducted to identify cases, defined as patients initiating HCV treatment between January 1996 and 2013, and controls, which were selected using incidence density sampling (3:1 ratio). Controls were matched to cases on date of enrollment. Conditional logistic regression was used to evaluate factors associated with HCV treatment initiation. Results. Among 208 treated cases and 624 untreated controls, the presence of advanced fibrosis (odds ratio [OR], 2.23; 95% confidence interval [CI], 1.26-3.95), recent active drug use (OR, 0.36; 95% CI, 0.19-0.69), and non-black race (OR, 2.01; 95% CI, 1.26-3.20) were independently associated with initiation of HCV therapy. An increasing proportion of missed visits was also independently associated with lower odds of HCV treatment (25%-49% missed visits [OR, 0.49; 95% CI, 0.27-0.91] and ≥50% missed visits [OR, 0.24; 95% CI, 0.12-0.48]). Conclusions. Interferon-free treatments may not be sufficient to fully overcome barriers to HCV care in HIV-infected patients. Interventions to increase engagement in care for HIV and substance use are needed to expand HCV treatment uptake.
KW - Direct-acting antivirals
KW - HCV treatment
KW - HIV/AIDS
KW - HIV/HCV coinfection
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U2 - 10.1093/OFID/OFX024
DO - 10.1093/OFID/OFX024
M3 - Article
AN - SCOPUS:85033597996
VL - 4
JO - Open Forum Infectious Diseases
JF - Open Forum Infectious Diseases
SN - 2328-8957
IS - 1
M1 - ofx024
ER -