Summary and Introduction
Summary
Background: True treatment rates and the impact of comorbidities on treatment rates for hepatitis C virus in the HCV–HIV-coinfected subjects are unknown.
Aim: To quantify the rates of treatment prescription and the effect of comorbidities on hepatitis C virus treatment rates in HCV–HIV-coinfected veterans.
Methods: The Veterans Affairs National Patient Care Database was used to identify all hepatitis C virus-infected subjects between 1999 and 2003 using ICD-9 codes. Demographics, comorbidities and pharmacy data were retrieved. We used logistic regression to compare the predictors of hepatitis C virus treatment in hepatitis C virus-monoinfected and HCV–HIV-coinfected subjects.
Findings: We identified 120 507 hepatitis C virus-infected subjects, of which 6502 were HIV coinfected. 12% of the hepatitis C virus-monoinfected and 7% of the -coinfected subjects were prescribed hepatitis C virus treatment (P < 0.0001). Those not prescribed treatment were older (48.6 years vs. 47.7 years, P = 0.007) and more likely to be black (52% vs. 32%, P < 0.0001). HIV coinfected was less likely to be prescribed hepatitis C virus treatment (OR 0.74, 95% CI: 0.67–0.82). Among the coinfected subjects, the following were associated with non-treatment (OR, 95% CI): black race (0.45, 0.35–0.57); Hispanic race (0.56, 0.38–0.82); drug use (0.68, 0.53–0.88); anaemia (0.17, 0.11–0.26); bipolar disorder (0.63, 0.40–0.99); major depression (0.72, 0.53–0.99); mild depression (0.47, 0.35–0.62).
Conclusions: A small number of HCV–HIV-coinfected veterans are prescribed treatment for hepatitis C virus. Non-treatment is associated with increasing age, minority race, drug use and psychiatric illness. Further studies are needed to determine the eligibility for treatment and reasons for non-treatment for hepatitis C virus.
Introduction
Pharmacological treatment for hepatitis C viral infection (HCV) has evolved over the last 20 years. The current standard of care treatment is a combination of pegylated interferon-α and ribavirin, which leads to sustained HCV eradication in 54–56% of the patients in clinical trials.[1-3] The sustained eradication rate is lower in HIV-infected subjects, and is reported to be 27–40% overall.[4, 5] Despite such advances in pharmacotherapy of HCV, most HCV-infected subjects are not prescribed treatment. Reasons for non-treatment are poorly understood, but involve non-adherence to follow-up visits, medical and psychiatric comorbidities, and ongoing substance use.[6-8]
True treatment rates for HCV are unknown. Previous studies on treatment patterns, eligibility and reasons for non-treatment have been conducted on subjects referred to tertiary care centres, and geographically limited populations.[6-8] Treatment rates are even lower in HIV-coinfected subjects.[9] Not all chronically infected subjects are candidates for treatment, and such low treatment rates need to be interpreted with caution, because true eligibility is difficult to determine in observational cohort studies. However, knowledge of true rates and predictors of treatment in larger and more representative populations is important to design future intervention strategies. We undertook this study to determine the rate and predictors of treatment in a national cohort of HCV–HIV-coinfected subjects treated in the United States Department of Veterans Affairs (VA) healthcare system.
