Hepatitis C care cascade in HIV patients at an urban clinic in the early direct-acting antiviral era

Jimmy Ma; Lemuel Non; Surachai Amornsawadwattana; Margaret A Olsen; Alexandria Garavaglia Wilson; Rachel M Presti

doi:10.1177/0956462419832750

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Hepatitis C care cascade in HIV patients at an urban clinic in the early direct-acting antiviral era

Journal article

Peer reviewed

Hepatitis C care cascade in HIV patients at an urban clinic in the early direct-acting antiviral era

Jimmy Ma, Lemuel Non, Surachai Amornsawadwattana, Margaret A Olsen, Alexandria Garavaglia Wilson and Rachel M Presti

International journal of STD & AIDS, Vol.30(9), pp.834-842

08/2019

DOI: 10.1177/0956462419832750

PMID: 31159714

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Abstract

Guidelines advocate universal, prompt treatment of hepatitis C (HCV) infection in HIV/HCV co-infected patients, but barriers to uptake of HCV direct-acting antivirals (DAAs) remain unclear in this population. This retrospective study investigated the care cascade from HCV diagnosis to sustained virologic response (SVR) at an urban infectious disease clinic in Saint Louis, Missouri during the first 18 months of interferon-free DAA availability in the United States. Of 1949 HIV patients seen in clinic, 91.9% were screened for HCV and 5.4% (n = 106) had chronic HCV infection with follow-up. Of these 106 co-infected patients, 100 underwent fibrosis testing, 55 were offered DAAs, 38 completed treatment, and 37 achieved SVR. Delayed DAA treatment was associated with no insurance, substance abuse, poor HIV control, and younger age. Providers delayed DAA treatment most commonly for substance abuse, psychiatric disease, and uncontrolled HIV. Mean time to insurance decision from initial prescription was 20.9 ± 29.6 days and mean time to final decision was 29.9 ± 40.1 days. DAAs are highly successful in co-infected patients in this early period but insurance delays and misconceptions from the interferon era can ultimately limit uptake. Addressing these factors in a comprehensive treatment model may bridge disparities and improve real-world SVRs.

Adult

Aged

Antiviral Agents - therapeutic use

Coinfection - drug therapy

Coinfection - virology

Female

Hepacivirus - isolation & purification

Hepatitis C - complications

Hepatitis C - drug therapy

Hepatitis C - epidemiology

Hepatitis C - virology

HIV Infections - complications

Humans

Interferons - therapeutic use

Male

Middle Aged

Missouri

Retrospective Studies

Sustained Virologic Response

Treatment Outcome

Details

Title: Subtitle: Hepatitis C care cascade in HIV patients at an urban clinic in the early direct-acting antiviral era
Creators: Jimmy Ma - Washington University in St. Louis
Lemuel Non - Washington University in St. Louis
Surachai Amornsawadwattana - Washington University in St. Louis
Margaret A Olsen - Washington University in St. Louis
Alexandria Garavaglia Wilson - University of Health Sciences and Pharmacy
Rachel M Presti - Washington University in St. Louis
Resource Type: Journal article
Publication Details: International journal of STD & AIDS, Vol.30(9), pp.834-842
DOI: 10.1177/0956462419832750
PMID: 31159714
ISSN: 0956-4624
eISSN: 1758-1052
Language: English
Date published: 08/2019
Academic Unit: Infectious Diseases; Internal Medicine
Record Identifier: 9984359925702771

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