HIV-HCV Coinfected Patients Receive Treatment for Chronic Hepatitis C Less Frequently Than HCV Monoinfected

By Marina Nunez, MD

“End-stage liver disease has become a leading cause of morbidity and mortality in HIV-infected patients since the introduction of HAART. Concerns regarding the proper treatment of patients with HIV-HCV coinfection have been growing.”

The aim of a study presented as a poster at this meeting was to characterize the treatment for HCV in a population of HCV-infected and HCV-HIV coinfected patients covered by the US Department of Veterans Affairs (VA) healthcare system. The data were obtained from the VA’s National Patient Care Databases. Patients with a minimum care of 6 months at the VA were included, and were followed-up between January 2001 and September 2004.

The sample included 26,987 patients with newly identified HCV chronic infection. At baseline, HIV-HCV coinfected patients (n= 3,139) were more likely to be younger (29 vs. 18%) and black (60% vs. 28%) compared with HCV-only patients (n=23,848). The majority (70%) of coinfected patients were receiving HIV treatment in the 12 months prior to the identification of HCV status.

As shown in the figure, during the follow-up period HCV treatment was initiated in 2,093 (7.8%) of all patients. HCV-only patients were twice as likely to initiate treatment as coinfected patients (p<.001). However, HIV treatment status was not significantly associated with HCV treatment among the coinfected.

Failure to receive HCV therapy was associated with prevalence of psychiatric, cardiovascular, endocrine, respiratory, circulatory, renal, and HIV-related conditions. Up to 63% of patients not receiving HCV therapy during the study period had a psychiatric condition at baseline compared with 49% of those receiving therapy during the same period (p<.001).

Among the treated, median time to first treatment was 16 months for HCV-only and 20 months for HIV-HCV coinfected patients (log-rank test, p<.001).

In summary, “Consistent with other studies, a small proportion of HCV patients were treated. Among black and HIV-HCV coinfected patients, treatment was less frequent and its initiation later.”  Therefore, much effort is needed to approach the obstacles (such as comorbidities including mental illness, lack of social support, resources, provider attitudes, etc...) that prevent these patients from receiving treatment.”

12/02/05

Reference
H K Tam and others. HCV treatment patterns and utilization for HCV moninfected and HCV/HIV coinfected patients in the Veterans administration. Abstract 1163. 56th annual meeting of the American Association for the Study of Liver Diseases (56th AASLD). November 11-15, 2005. San Francisco, CA.