title: The rate of treatment of chronic hepatitis C in patients co-infected with HIV in an urban medical centre.
abstract: Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) co-infection is common. HIV co-infection results in a higher rate of histologic progression and shorter interval to HCV-related cirrhosis. Successful treatment of HCV with interferon-based therapy reduces the morbidity and mortality of patients. Significant factors may limit the availability of treatment in co-infected patients. The rate of treatment of HCV and limiting factors to treatment in a co-infected population in an urban setting were determined. A retrospective review of co-infected patients was conducted at our liver and gastrointestinal (GI) clinics for treatment of HCV from July 2001 to June 2002. Treatment of HCV and reasons for nontreatment were recorded. A total of 104 HCV/HIV co-infected patients were identified. Seventy-two per cent were males. Mean age was 47.2 years (32-72). Seventy-four of the 82 (90%) with identifiable risk factors for HCV infection had a history of intravenous drug use (IVDU). Twenty per cent (21/104) of the total underwent a liver biopsy. Sixty-seven per cent who had a liver biopsy were treated. Overall, sixteen patients were treated. Eighty-eight (85%) patients were not treated for the following reasons: 13 refused treatment, and 75 were ineligible. Of the ineligible patients, 40% were noncompliant with visits, 15% were active substance abusers, 13% had decompensated cirrhosis, 8% had significant active psychiatric conditions and 24% had significant co-morbid disease. A majority of patients co-infected with HCV/HIV had a IVDU history. Most co-infected patients were not eligible for HCV treatment. A majority of noncandidates had potentially modifiable psychosocial factors leading to nontreatment.
authors.affiliation: Division of Digestive Diseases, Department of Medicine, Beth Israel Medical Center, New York, NY, USA.
authors.forename: A
authors.initials: A
authors.lastname: Restrepo
authors.forename: T C
authors.initials: TC
authors.lastname: Johnson
authors.forename: D
authors.initials: D
authors.lastname: Widjaja
authors.forename: L
authors.initials: L
authors.lastname: Yarmus
authors.forename: K
authors.initials: K
authors.lastname: Meyer
authors.forename: D J
authors.initials: DJ
authors.lastname: Clain
authors.forename: H C
authors.initials: HC
authors.lastname: Bodenheimer
authors.forename: A D
authors.initials: AD
authors.lastname: Min
mesh_terms: D000328:Adult; D000368:Aged; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000209:etiology / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019562:Viral Load