Hepatitis C coinfection is independently associated with decreased adherence to antiretroviral therapy in a population-based HIV cohort.
OBJECTIVE
To characterize the impact of hepatitis C (HCV) serostatus on adherence to antiretroviral treatment (ART) among HIV-infected adults initiating ART.


METHODS
The British Columbia HIV/AIDS Drug Treatment Program distributes, at no cost, all ART in this Canadian province. Eligible individuals used triple combination ART as their first HIV therapy and had documented HCV serology. Statistical analyses used parametric and non-parametric methods, including multivariate logistic regression. The primary outcome was > or = 95% adherence, defined as receiving > or = 95% of prescription refills during the first year of antiretroviral therapy.


RESULTS
There were 1186 patients eligible for analysis, including 606 (51%) positive for HCV antibody and 580 (49%) who were negative. In adjusted analyses, adherence was independently associated with HCV seropositivity [adjusted odds ratio (AOR), 0.48; 95% confidence interval (CI), 0.23-0.97; P = 0.003], higher plasma albumin levels (AOR, 1.07; 95% CI, 1.01-1.12; P = 0.002) and male gender (AOR, 2.53; 95% CI, 1.04-6.15; P = 0.017), but not with injection drug use (IDU), age or other markers of liver injury. There was no evidence of an interaction between HCV and liver injury in adjusted analyses; comparing different strata of HCV and IDU confirmed that HCV was associated with poor adherence independent of IDU.


CONCLUSIONS
HCV-coinfected individuals and those with lower albumin are less likely to be adherent to their ART.
Braitstein
Paula
P
British Columbia Center for Excellence in HIV/AIDS, University of British Columbia, Vancouver, Canada. pbraitstein@ispm.unibe.ch
Justice
Amy
A
Bangsberg
David R
DR
Yip
Benita
B
Alfonso
Victoria
V
Schechter
Martin T
MT
Hogg
Robert S
RS
Montaner
Julio S G
JS
D000328:Adult; D000418:Albumins / Q000032:analysis; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D015497:HIV-1; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010349:Patient Compliance; D012737:Sex Factors; D015819:Substance Abuse, Intravenous / Q000150:complications
D000418:Albumins