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Limited effectiveness of antiviral treatment for hepatitis C in an urban HIV clinic

Mehta, Shruti Ha; Lucas, Gregory Ma,b; Mirel, Lisa Ba; Torbenson, Michaelb; Higgins, Yvonneb; Moore, Richard Da,b; Thomas, David La,b; Sulkowski, Mark Sa

doi: 10.1097/QAD.0b013e32801086da
Epidemiology and Social

Objective: To evaluate predictors and trends of referral for hepatitis C virus (HCV) care, clinic attendance and treatment in an urban HIV clinic.

Design and methods: A retrospective cohort analysis in which 845 of 1318 co-infected adults who attended the Johns Hopkins HIV clinic between 1998 and 2003 after an on-site viral hepatitis clinic was opened, attended regularly (≥ 1 visit/year for ≥ 2 years). Logistic regression was used to examine predictors of referral.

Results: A total of 277 (33%) of 845 were referred for HCV care. Independent predictors of referral included percentage elevated alanine aminotransferase levels [adjusted odds ratio (AOR) for 10% increase,1.16; 95% confidence interval (CI), 1.10–1.22] and CD4 cell count > 350 cells/μl (AOR, 3.20; 95% CI, 2.10–4.90), while injection drug use was a barrier to referral (AOR, 0.26; 95% CI, 0.11–0.64). Overall referral rate increased from < 1% in 1998 to 28% in 2003; however, even in 2003, 65% of those with CD4 cell count > 200 cells/μl were not referred. One hundred and eighty-five (67%) of 277 referred kept their appointment, of whom 32% failed to complete a pre-treatment evaluation. Of the remaining 125, only 69 (55%) were medically eligible for treatment, and 29 (42%) underwent HCV treatment. Ninety percent of 29 were infected with genotype 1 and 70% were African American; six (21%) achieved sustained virologic response (SVR). Only 0.7% of the full cohort achieved SVR.

Conclusions: Although the potential for SVR and the recent marked increase in access to HCV care are encouraging, overall effectiveness of anti-HCV treatment in this urban, chiefly African American, HCV genotype 1 HIV clinic is extremely low. New therapies and treatment strategies are an urgent medical need.

From the aDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA

bDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Received 11 May, 2006

Revised 3 August, 2006

Accepted 5 September, 2006

Correspondence to Mark S. Sulkowski, MD, Department of Medicine, 1830 E Monument St, Suite 455, Baltimore, MD 21287, USA. E-mail: msulkows@jhmi.edu

© 2006 Lippincott Williams & Wilkins, Inc.