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HCV Screening and Treatment Uptake Among Patients in HIV Care During 2014–2015

Radwan, Daniel, MPH, MBAa; Cachay, Edward, MD, MASb; Falade-Nwulia, Oluwaseun, MBBS, MPHa; Moore, Richard D., MD, MHSa; Westergaard, Ryan, MD, PhD, MPHc; Mathews, William Christopher, MD, MSPHb; Aberg, Judith, MDd; Cheever, Laura, MD, ScMe; Gebo, Kelly A., MD, MPHa for the HIV Research Network

JAIDS Journal of Acquired Immune Deficiency Syndromes: April 15, 2019 - Volume 80 - Issue 5 - p 559–567
doi: 10.1097/QAI.0000000000001949
Clinical Science
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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.

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.

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).

Supported by the Agency for Healthcare Research and Quality (HHSA290201100007C), the Health Resources and Services Administration (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.

Received June 25, 2018

Accepted December 10, 2018

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