title: Barriers to treatment of hepatitis C in HIV/HCV-coinfected adults with alcohol problems.
abstract: BACKGROUND
  Alcohol use and human immune deficiency virus (HIV) infection are both associated with accelerated progression of hepatitis C virus (HCV) disease and reduced response rates to interferon therapy. In this study, we assessed the prevalence of barriers to interferon treatment in a population of HIV/HCV-coinfected patients with current or past alcohol problems and the extent to which they received treatment to address the barriers.
  
  
  METHODS
  This is a cross-sectional, descriptive analysis of baseline data from a prospective study assessing the impact of HCV and alcohol use on HIV disease progression. Using consensus guidelines, subjects were categorized as having absolute, relative, or no contraindications to interferon therapy for HCV. Absolute contraindications to treatment included heavy alcohol use, decompensated liver disease, CD4 cell count <100 cells/microL, recent needle sharing, and suicidal ideation. Relative contraindications included moderate alcohol use, recent injection drug use, depressive symptoms, and CD4 cell count from 100 to 199 cells/microL.
  
  
  RESULTS
  Of 401 HIV-infected subjects, 200 were HCV RNA-positive. Fifty-three percent had an absolute contraindication to interferon therapy, 35% a relative but no absolute contraindication, and only 12% had no contraindication. Of those with an absolute contraindication, 61% reported heavy drinking and the majority (88%) had multiple contraindications. These contraindications were present despite the fact that over 50% were in receipt of substance abuse and mental health treatment.
  
  
  CONCLUSIONS
  Continued alcohol and drug use as well as depressive symptoms are the major barriers to interferon therapy in HCV/HIV-coinfected subjects and these barriers persist despite high treatment rates for these problems. Therefore, more intensive treatments of alcohol, drug, and mental health issues are needed to improve HCV treatment eligibility in HCV/HIV-coinfected persons.
authors.affiliation: Section of Gastroenterology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts 02118, USA. david.nunes@bmc.org
authors.forename: David
authors.initials: D
authors.lastname: Nunes
authors.forename: Richard
authors.initials: R
authors.lastname: Saitz
authors.forename: Howard
authors.initials: H
authors.lastname: Libman
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Cheng
authors.forename: John
authors.initials: J
authors.lastname: Vidaver
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications* / Q000523:psychology; D000998:Antiviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D000075202:Contraindications; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000523:psychology; D006526:Hepatitis C / Q000150:complications* / Q000523:psychology / Q000628:therapy*; D006801:Humans; D007370:Interferon Type I / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D011994:Recombinant Proteins; D015819:Substance Abuse, Intravenous
chemical_list: D000998:Antiviral Agents; D007370:Interferon Type I; D012367:RNA, Viral; D011994:Recombinant Proteins