title: Hepatitis C virus infection in San Francisco's HIV-infected urban poor.
abstract: OBJECTIVE
  To measure Hepatitis C Virus (HCV) prevalence, incidence, and initiation of HCV therapy in a representative HIV-infected cohort of the urban poor.
  
  
  METHODS
  Cohort analysis.
  
  
  METHODS
  The Research and Access to Care for the Homeless (REACH) Cohort is a systematic sample of HIV-infected marginally housed individuals identified from single-room occupancy hotels, homeless shelters, and free lunch programs in San Francisco.
  
  
  METHODS
  Two hundred forty-nine participants with 28.9 months (median) of follow-up were studied. Mean age was 44 (range 24 to 75, standard deviation 8.4) years. Eighty-two percent were male, 43% were African-American, 64% were lifetime injection drug users, and 24% had been on the street or in a shelter in the prior month.
  
  
  METHODS
  We measured HCV testing and treatment history with structured interviews; additionally, participants were tested for HCV antibodies (EIA-2) with RNA viral load confirmation.
  
  
  RESULTS
  At baseline, 172 (69.1%) were HCV-positive and 182 (73.1%) were HCV-positive at follow-up, including 155 (62.2%) with viremia. HCV-positive status was associated with having injected drugs, elevated serum alanine aminotransferase, homelessness in the last 1 year, and more severe depressive symptoms. The incidence of new HCV infection was 4.63% per person-year (ppy; 95% confidence interval, 2.31 to 8.13) in the entire cohort and 16.77% ppy among injection drug users. The prevalence of HCV antibody-negative HCV-viremia was 13.2% (10/76). Nonwhites were less likely to receive HCV testing and subspecialty referral, controlled for drug use and other confounders. Sixty-eight percent (123/182) were aware treatment was available; however, only 3.8% (7/182) or 1.16% ppy received HCV treatment.
  
  
  CONCLUSIONS
  While HCV infection is common, HCV treatment is rare in the HIV-HCV coinfected urban poor. Urban poor, nonwhite individuals are less likely to receive HCV testing and subspecialty referral than their white counterparts. Antibody-negative infection may complicate screening and diagnosis in HIV-infected persons. J
authors.affiliation: Division of Infectious Diseases, San Francisco General Hospital, San Francisco, California, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hall
authors.forename: Edwin D
authors.initials: ED
authors.lastname: Charlebois
authors.forename: Judith A
authors.initials: JA
authors.lastname: Hahn
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Moss
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
mesh_terms: D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000032:analysis; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D016174:Hepacivirus / Q000276:immunology; D006526:Hepatitis C / Q000453:epidemiology*; D006703:Ill-Housed Persons; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012495:San Francisco / Q000453:epidemiology; D015819:Substance Abuse, Intravenous / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data
chemical_list: D000914:Antibodies, Viral