title: Equitable access to HCV care in HIV-HCV co-infection can be achieved despite barriers to health care provision.
abstract: Language barrier, race, immigration status, mental health illness, substance abuse and socioeconomic status are often not considered when evaluating hepatitis C virus (HCV) sustained virological response (SVR) in human immunodeficiency virus (HIV) infection. The influence of these factors on HCV work-up, treatment initiation and SVR were assessed in an HIV-HCV coinfected population and compared to patients with HCV mono-infection. The setting was a publicly funded, urban-based, multidisciplinary viral hepatitis clinic. A clinical database was utilized to identify HIV and HCV consults between June 2000 and June 2007. Measures of access to HCV care (ie, liver biopsy and HCV antiviral initiation) and SVR as a function of the above variables were evaluated and compared between patients with HIV-HCV and HCV. HIV-HCV co-infected (n = 106) and HCV mono-infected (n = 802) patients were evaluated. HIV-HCV patients were more often white (94% versus 84%) and male (87% versus 69%). Bridging fibrosis or cirrhosis on biopsy was more frequent in HIV-HCV (37% versus 22%; P = 0.03). HIV infection itself did not influence access to biopsy (50% versus 52%) or treatment initiation (39% versus 38%). Race, language barrier, immigration status, injection drug history and socioeconomic status did not influence access to biopsy or treatment. SVR was 54% in HCV and 30% in HIV-HCV (P = 0.003). Genotype and HIV were the only evaluated variables to predict SVR. Within the context of a socialized, multidisciplinary clinic, HIV-HCV co-infected patients received similar access to HCV work-up and care as HCV mono-infected patients. SVR is diminished in HIV-HCV co-infection independent of language barrier, race, immigration status, or socioeconomic status.
authors.affiliation: The University of Ottawa Division of Infectious Diseases Viral Hepatitis Program, Ottawa, Canada.
authors.forename: Curtis L
authors.initials: CL
authors.lastname: Cooper
authors.forename: Celine
authors.initials: C
authors.lastname: Giordano
authors.forename: Dave
authors.initials: D
authors.lastname: Mackie
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Mills
references.citation: J Psychosom Res. 2000 Nov;49(5):311-7
references.pmid: 11164055
references.citation: Clin Infect Dis. 2003 Jan 1;36(1):97-100
references.pmid: 12491208
references.citation: Health Serv Res. 2003 Jun;38(3):789-808
references.pmid: 12822913
references.citation: Clin Infect Dis. 2002 Apr 1;34(7):984-90
references.pmid: 11880965
references.citation: J Viral Hepat. 2007 Mar;14(3):183-8
references.pmid: 17305884
references.citation: AIDS. 2005 Oct;19 Suppl 3:S208-14
references.pmid: 16251820
references.citation: Gut. 2007 Mar;56(3):385-9
references.pmid: 17005764
references.citation: N Engl J Med. 2004 Jul 29;351(5):438-50
references.pmid: 15282351
references.citation: Lancet. 2001 Sep 22;358(9286):958-65
references.pmid: 11583749
references.citation: J Infect Dis. 1999 May;179(5):1254-8
references.pmid: 10191232
references.citation: Hepatology. 1999 Oct;30(4):1054-8
references.pmid: 10498659
references.citation: J Subst Abuse Treat. 2002 Oct;23(3):225-30
references.pmid: 12392809
references.citation: CMAJ. 2001 Sep 4;165(5):565-70
references.pmid: 11563208
references.citation: Harm Reduct J. 2006 Nov 10;3:31
references.pmid: 17096852
references.citation: J Gen Intern Med. 2005 Nov;20(11):1050-6
references.pmid: 16307633
references.citation: Soc Sci Med. 2000 Jul;51(1):123-33
references.pmid: 10817475
references.citation: Health Rep. 2007 Feb;18(1):23-35
references.pmid: 17441441
references.citation: JAMA. 2004 Dec 15;292(23):2839-48
references.pmid: 15598915
references.citation: J Am Acad Dermatol. 2006 Feb;54(2):331-5
references.pmid: 16443069
references.citation: Can J Gastroenterol. 2006 Feb;20(2):81-6
references.pmid: 16482232
references.citation: Psychiatr Serv. 2006 Mar;57(3):317-24
references.pmid: 16524988
references.citation: J Gen Intern Med. 2001 Jul;16(7):468-74
references.pmid: 11520385
references.citation: J Viral Hepat. 2005 Jan;12(1):86-90
references.pmid: 15655053
references.citation: N Engl J Med. 2002 Sep 26;347(13):975-82
references.pmid: 12324553
references.citation: Milbank Q. 2006;84(1):111-33
references.pmid: 16529570
references.citation: Eur J Gastroenterol Hepatol. 2009 Feb;21(2):131-6
references.pmid: 19092675
references.citation: World J Gastroenterol. 2007 Feb 21;13(7):1074-8
references.pmid: 17373742
references.citation: AIDS. 2008 Aug;22 Suppl 2:S67-79
references.pmid: 18641472