Factors associated with successful referral for clinical care of drug users with chronic hepatitis C who have or are at risk for HIV infection.
The objective of this study was to determine outcomes of referring drug users (DUs) with chronic hepatitis C for clinical evaluation and care. Two hundred twenty-eight persons with detectable hepatitis C virus RNA were given expedited referrals for evaluation and possible treatment of hepatitis C from a prospective study cohort of current and former opiate-addicted DUs. Four outcomes were analyzed: accepted referral, arrived for clinical evaluation, had liver biopsy, and received treatment. One hundred twenty-seven participants (56%) accepted referral, of whom 54 (43%) arrived for evaluation. Of these participants, 12 (22%) had liver biopsy, and 4 (7%) were treated. Multivariate logistic regression revealed that HIV-infected DUs were significantly less likely to accept referral (adjusted odds ratio [O(Radj)], 0.51; 95% confidence interval [CI], 0.30-0.88), and older participants were more likely to keep an appointment (O(Radj), 1.06/y; 95% CI, 1.00-1.12). Of HIV-seropositive participants, those with a history of injection were more likely to accept referral (O(Radj), 3.60; 95% CI, 1.08-11.96), and those with higher HIV load (O(Radj), 0.50/log10; 95% CI, 0.26-0.94) and Hispanic ethnicity (O(Radj), 0.26; 95% CI, 0.07-0.89) were less likely to keep an appointment. Despite expedited referrals for hepatitis C care, only a few participants received an evaluation, and even far fewer were treated. Because increasingly effective treatment is available, better methods are urgently needed to improve evaluation and treatment of HCV-infected DUs, including those coinfected with HIV.
Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10467, USA. dfishbein@nyc.rr.com
Dawn A
DA
Fishbein
Yungtai
Y
Lo
John F
JF
Reinus
Marc N
MN
Gourevitch
Robert S
RS
Klein
D000328:Adult; D001706:Biopsy; D018791:CD4 Lymphocyte Count; D019970:Cocaine-Related Disorders; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000276:immunology; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000628:therapy; D006801:Humans; D008099:Liver / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012017:Referral and Consultation; D012044:Regression Analysis; D012307:Risk Factors; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000150:complications*; D016896:Treatment Outcome