TY - JOUR
T1 - HCV Screening and Treatment Uptake among Patients in HIV Care during 2014-2015
AU - Radwan, Daniel
AU - Cachay, Edward
AU - Falade-Nwulia, Oluwaseun
AU - Moore, Richard D.
AU - Westergaard, Ryan
AU - Mathews, William Christopher
AU - Aberg, Judith
AU - Cheever, Laura
AU - Gebo, Kelly A.
N1 - Funding Information:
Received for publication June 25, 2018; accepted December 10, 2018. From the aJohns Hopkins University School of Medicine, Baltimore, MD; bUniversity of California San Diego, San Diego, CA; cUniversity of Wisconsin, Madison, WI; dIcahn School at Mt. Sinai, New York, NY; and eHealth Resources and Services Administration, Rockville, MD. Supported by the Agency for Healthcare Research and Quality (HHSA290201100007C), the Health Resources and Services Adminis-tration (HHSH250201600009C), the National Institutes of Health (U01 DA036935, P30 AI094189), the Clinical Investigation and Biostatistics Core of the UC San Diego Center for AIDS Research (P30 AI036214), and National Center for Research Resources and the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (1UL1TR001079). Presented at the Annual Conference on Retroviruses and Opportunistic Infections (CROI); March 4–7, 2018; Boston, MA. The authors have no conflicts of interest to disclose. Correspondence to: Kelly A. Gebo, MD MPH, Johns Hopkins University School of Medicine, Room 435, 1830 East Monument Street, Baltimore, MD 212187 (e-mail: kgebo@jhmi.edu). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Publisher Copyright:
© 2019 Wolters Kluwer Health, Inc.
PY - 2019/4/15
Y1 - 2019/4/15
N2 - Background:Despite the high prevalence of hepatitis C virus (HCV) among persons living with HIV (PWH), the prevalence of HCV screening, treatment, and sustained virologic response (SVR) is unknown. This study aims to characterize the continuum of HCV screening and treatment among PWH in HIV care.Setting:Adult patients enrolled at 12 sites of the HIV Research Network located in 3 regions of the United States were included.Methods:We examined the prevalence of HCV screening, HCV coinfection, direct-acting antiretroviral (DAA) treatment, and SVR-12 between 2014 and 2015. Multivariate logistic regression was performed to identify characteristics associated with outcomes, adjusted for site.Results:Among 29,071 PWH (age 18-87, 74.8% male, 44.4% black), 77.9% were screened for HCV antibodies; 94.6% of those screened had a confirmatory HCV RNA viral load test. Among those tested, 61.1% were determined to have chronic HCV. We estimate that only 23.4% of those eligible for DAA were prescribed DAA, and only 17.8% of those eligible evidenced initiating DAA treatment. Those who initiated treatment achieved SVR-12 at a rate of 95.2%. Blacks and people who inject drugs (PWID) were more likely to be screened for HCV than whites or those with heterosexual risk. Persons older than 40 years, whites, Hispanics, and PWID [adjusted odds ratio (AOR) 8.70 (7.74 to 9.78)] were more likely to be coinfected than their counterparts. When examining treatment with DAA, persons older than 50 years, on antiretroviral therapy [AOR 2.27 (1.11 to 4.64)], with HIV-1 RNA <400 [AOR 2.67 (1.71 to 4.18)], and those with higher Fib-4 scores were more likely to be treated with DAA.Conclusions:Although rates of screening for HCV among PWH are high, screening remains far from comprehensive. Rates of SVR were high, consistent with previously published literature. Additional programs to improve screening and make treatment more widely available will help reduce the impact of HCV morbidity among PWH.
AB - Background:Despite the high prevalence of hepatitis C virus (HCV) among persons living with HIV (PWH), the prevalence of HCV screening, treatment, and sustained virologic response (SVR) is unknown. This study aims to characterize the continuum of HCV screening and treatment among PWH in HIV care.Setting:Adult patients enrolled at 12 sites of the HIV Research Network located in 3 regions of the United States were included.Methods:We examined the prevalence of HCV screening, HCV coinfection, direct-acting antiretroviral (DAA) treatment, and SVR-12 between 2014 and 2015. Multivariate logistic regression was performed to identify characteristics associated with outcomes, adjusted for site.Results:Among 29,071 PWH (age 18-87, 74.8% male, 44.4% black), 77.9% were screened for HCV antibodies; 94.6% of those screened had a confirmatory HCV RNA viral load test. Among those tested, 61.1% were determined to have chronic HCV. We estimate that only 23.4% of those eligible for DAA were prescribed DAA, and only 17.8% of those eligible evidenced initiating DAA treatment. Those who initiated treatment achieved SVR-12 at a rate of 95.2%. Blacks and people who inject drugs (PWID) were more likely to be screened for HCV than whites or those with heterosexual risk. Persons older than 40 years, whites, Hispanics, and PWID [adjusted odds ratio (AOR) 8.70 (7.74 to 9.78)] were more likely to be coinfected than their counterparts. When examining treatment with DAA, persons older than 50 years, on antiretroviral therapy [AOR 2.27 (1.11 to 4.64)], with HIV-1 RNA <400 [AOR 2.67 (1.71 to 4.18)], and those with higher Fib-4 scores were more likely to be treated with DAA.Conclusions:Although rates of screening for HCV among PWH are high, screening remains far from comprehensive. Rates of SVR were high, consistent with previously published literature. Additional programs to improve screening and make treatment more widely available will help reduce the impact of HCV morbidity among PWH.
KW - DAA
KW - HCV
KW - HIV
KW - continuum of care
KW - hepatitis C
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U2 - 10.1097/QAI.0000000000001949
DO - 10.1097/QAI.0000000000001949
M3 - Article
C2 - 30649030
AN - SCOPUS:85062005639
VL - 80
SP - 559
EP - 567
JO - Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology
JF - Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology
SN - 1525-4135
IS - 5
ER -