Hepatitis C treatment uptake and response among HIV/HCV-coinfected patients in a large integrated healthcare system
U.S guidelines recommend that patients coinfected with HIV and hepatitis C virus (HCV) be prioritized for HCV treatment with direct-acting antiviral agents (DAAs), but the high cost of DAAs may contribute to disparities in treatment uptake and outcomes. We evaluated DAA initiation and effectiveness...
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| Veröffentlicht in: | International journal of STD & AIDS 2019-05, Vol.30 (7), p.689-695 |
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| container_title | International journal of STD & AIDS |
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| creator | Lam, Jennifer O. Hurley, Leo B. Chamberland, Scott Champsi, Jamila H. Gittleman, Laura C. Korn, Daniel G. Lai, Jennifer B. Quesenberry, Charles P. Ready, Joanna Saxena, Varun Seo, Suk Witt, David J. Silverberg, Michael J. Marcus, Julia L. |
| description | U.S guidelines recommend that patients coinfected with HIV and hepatitis C virus (HCV) be prioritized for HCV treatment with direct-acting antiviral agents (DAAs), but the high cost of DAAs may contribute to disparities in treatment uptake and outcomes. We evaluated DAA initiation and effectiveness in HIV/HCV-coinfected patients in a U.S.-based healthcare system during October 2014–December 2017. Of 462 HIV/HCV-coinfected patients, 276 initiated DAAs (70% cumulative proportion treated over 3 years). Lower likelihood of DAA initiation was observed among patients with Medicare (government-sponsored insurance) vs. commercial insurance (aRR=0.62, 95% CI=0.46-0.84), patients with drug abuse diagnoses (aRR=0.72, 95% CI=0.54-0.97), patients with CD4 count |
| doi_str_mv | 10.1177/0956462419836520 |
| format | Article |
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We evaluated DAA initiation and effectiveness in HIV/HCV-coinfected patients in a U.S.-based healthcare system during October 2014–December 2017. Of 462 HIV/HCV-coinfected patients, 276 initiated DAAs (70% cumulative proportion treated over 3 years). Lower likelihood of DAA initiation was observed among patients with Medicare (government-sponsored insurance) vs. commercial insurance (aRR=0.62, 95% CI=0.46-0.84), patients with drug abuse diagnoses (aRR=0.72, 95% CI=0.54-0.97), patients with CD4 count <200 vs. ≥500 (aRR=0.45, 95% CI=0.23-0.91) and patients without prior HCV treatment (aRR=0.68, 95% CI=0.48-0.97). There were no significant differences in DAA initiation by age, sex, race/ethnicity, socioeconomic status, HIV-transmission risk, alcohol use, smoking, fibrosis level, HIV RNA levels, ART use, hepatitis B infection, or number of outpatient visits. 95% of patients achieved SVR. We found little evidence of sociodemographic disparities in DAA initiation among HIV/HCV-coinfected patients, and SVR rates were high. Efforts are needed to increase DAA uptake among coinfected Medicare enrollees, patients with drug abuse diagnoses, patients with low CD4 count, and patients receiving first-time HCV treatment.</description><identifier>ISSN: 0956-4624</identifier><identifier>EISSN: 1758-1052</identifier><identifier>DOI: 10.1177/0956462419836520</identifier><identifier>PMID: 31046611</identifier><language>eng</language><ispartof>International journal of STD & AIDS, 2019-05, Vol.30 (7), p.689-695</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids></links><search><creatorcontrib>Lam, Jennifer O.</creatorcontrib><creatorcontrib>Hurley, Leo B.</creatorcontrib><creatorcontrib>Chamberland, Scott</creatorcontrib><creatorcontrib>Champsi, Jamila H.</creatorcontrib><creatorcontrib>Gittleman, Laura C.</creatorcontrib><creatorcontrib>Korn, Daniel G.</creatorcontrib><creatorcontrib>Lai, Jennifer B.</creatorcontrib><creatorcontrib>Quesenberry, Charles P.</creatorcontrib><creatorcontrib>Ready, Joanna</creatorcontrib><creatorcontrib>Saxena, Varun</creatorcontrib><creatorcontrib>Seo, Suk</creatorcontrib><creatorcontrib>Witt, David J.</creatorcontrib><creatorcontrib>Silverberg, Michael J.</creatorcontrib><creatorcontrib>Marcus, Julia L.</creatorcontrib><title>Hepatitis C treatment uptake and response among HIV/HCV-coinfected patients in a large integrated healthcare system</title><title>International journal of STD & AIDS</title><description>U.S guidelines recommend that patients coinfected with HIV and hepatitis C virus (HCV) be prioritized for HCV treatment with direct-acting antiviral agents (DAAs), but the high cost of DAAs may contribute to disparities in treatment uptake and outcomes. We evaluated DAA initiation and effectiveness in HIV/HCV-coinfected patients in a U.S.-based healthcare system during October 2014–December 2017. Of 462 HIV/HCV-coinfected patients, 276 initiated DAAs (70% cumulative proportion treated over 3 years). Lower likelihood of DAA initiation was observed among patients with Medicare (government-sponsored insurance) vs. commercial insurance (aRR=0.62, 95% CI=0.46-0.84), patients with drug abuse diagnoses (aRR=0.72, 95% CI=0.54-0.97), patients with CD4 count <200 vs. ≥500 (aRR=0.45, 95% CI=0.23-0.91) and patients without prior HCV treatment (aRR=0.68, 95% CI=0.48-0.97). There were no significant differences in DAA initiation by age, sex, race/ethnicity, socioeconomic status, HIV-transmission risk, alcohol use, smoking, fibrosis level, HIV RNA levels, ART use, hepatitis B infection, or number of outpatient visits. 95% of patients achieved SVR. We found little evidence of sociodemographic disparities in DAA initiation among HIV/HCV-coinfected patients, and SVR rates were high. 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We evaluated DAA initiation and effectiveness in HIV/HCV-coinfected patients in a U.S.-based healthcare system during October 2014–December 2017. Of 462 HIV/HCV-coinfected patients, 276 initiated DAAs (70% cumulative proportion treated over 3 years). Lower likelihood of DAA initiation was observed among patients with Medicare (government-sponsored insurance) vs. commercial insurance (aRR=0.62, 95% CI=0.46-0.84), patients with drug abuse diagnoses (aRR=0.72, 95% CI=0.54-0.97), patients with CD4 count <200 vs. ≥500 (aRR=0.45, 95% CI=0.23-0.91) and patients without prior HCV treatment (aRR=0.68, 95% CI=0.48-0.97). There were no significant differences in DAA initiation by age, sex, race/ethnicity, socioeconomic status, HIV-transmission risk, alcohol use, smoking, fibrosis level, HIV RNA levels, ART use, hepatitis B infection, or number of outpatient visits. 95% of patients achieved SVR. We found little evidence of sociodemographic disparities in DAA initiation among HIV/HCV-coinfected patients, and SVR rates were high. Efforts are needed to increase DAA uptake among coinfected Medicare enrollees, patients with drug abuse diagnoses, patients with low CD4 count, and patients receiving first-time HCV treatment.</abstract><pmid>31046611</pmid><doi>10.1177/0956462419836520</doi></addata></record> |
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| source | SAGE Complete |
| title | Hepatitis C treatment uptake and response among HIV/HCV-coinfected patients in a large integrated healthcare system |
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