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Hepatitis C coinfection is independently associated with decreased adherence to antiretroviral therapy in a population-based HIV cohort

Braitstein, Paulaa,b,e; Justice, Amyf; Bangsberg, David Rg; Yip, Benitaa; Alfonso, Victoriaa,c; Schechter, Martin Ta,b; Hogg, Robert Sa,b; Montaner, Julio SGa,d

doi: 10.1097/01.aids.0000198091.70325.f4
Basic Science

Objective: To characterize the impact of hepatitis C (HCV) serostatus on adherence to antiretroviral treatment (ART) among HIV-infected adults initiating ART.

Methods: The British Columbia HIV/AIDS Drug Treatment Program distributes, at no cost, all ART in this Canadian province. Eligible individuals used triple combination ART as their first HIV therapy and had documented HCV serology. Statistical analyses used parametric and non-parametric methods, including multivariate logistic regression. The primary outcome was ≥ 95% adherence, defined as receiving ≥ 95% of prescription refills during the first year of antiretroviral therapy.

Results: There were 1186 patients eligible for analysis, including 606 (51%) positive for HCV antibody and 580 (49%) who were negative. In adjusted analyses, adherence was independently associated with HCV seropositivity [adjusted odds ratio (AOR), 0.48; 95% confidence interval (CI), 0.23–0.97; P = 0.003], higher plasma albumin levels (AOR, 1.07; 95% CI, 1.01–1.12; P = 0.002) and male gender (AOR, 2.53; 95% CI, 1.04–6.15; P = 0.017), but not with injection drug use (IDU), age or other markers of liver injury. There was no evidence of an interaction between HCV and liver injury in adjusted analyses; comparing different strata of HCV and IDU confirmed that HCV was associated with poor adherence independent of IDU.

Conclusions: HCV-coinfected individuals and those with lower albumin are less likely to be adherent to their ART.

From the aBritish Columbia Center for Excellence in HIV/AIDS

bDepartment of Health Care and Epidemiology

cDepartment of Counseling Psychology

dDepartment of Medicine, University of British Columbia, Vancouver, Canada

eInstitute of Social and Preventive Medicine, University of Bern, Bern, Switzerland

fYale University School of Medicine and New Haven VA Connecticut Healthcare System, West Haven, Connecticut

gUniversity of California–San Francisco AIDS Research Institute, USA.

Received 6 June, 2005

Revised 23 September, 2005

Accepted 3 October, 2005

Correspondence to Dr P. Braitstein, Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, Bern CH-3012, Switzerland. E-mail:

© 2006 Lippincott Williams & Wilkins, Inc.