title: Challenges facing providers caring for HIV/HCV-coinfected patients.
abstract: Despite the high prevalence of hepatitis C virus (HCV) infection among injection drug users also infected with human immunodeficiency virus (HIV), and the synergistic adverse effect of the two diseases on patients' health and survival, research on the clinical management of these patients and particularly the low uptake of HCV therapy is limited. We conducted qualitative interviews with 17 HIV providers from two urban public hospitals. We discovered that the limitations of the current state of medical knowledge, the severe side effects of HIV and HCV therapies, and the psychosocial vulnerability of HIV/HCV-coinfected patients combined with their resistance to becoming informed about HCV posed significant challenges for providers. To contend with these challenges, providers incorporated key dimensions of patient-centered medicine in their practice, such as considering their patients' psychosocial profiles and the meaning patients assign to being coinfected, and finding ways to engage their patients in a therapeutic alliance.
authors.affiliation: Columbia University, New York, New York 10032, USA. hl11@columbia.edu
authors.forename: Helen-Maria
authors.initials: HM
authors.lastname: Lekas
authors.forename: Karolynn
authors.initials: K
authors.lastname: Siegel
authors.forename: Jason
authors.initials: J
authors.lastname: Leider
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D056486:Chemical and Drug Induced Liver Injury / Q000378:metabolism; D060085:Coinfection / Q000188:drug therapy*; D004347:Drug Interactions; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006526:Hepatitis C / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D006786:Hospitals, Urban; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D001523:Mental Disorders / Q000139:chemically induced; D008875:Middle Aged; D010349:Patient Compliance; D036301:Qualitative Research; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents