Department of Medicine, Owen Clinic, University of California at San Diego, 200 W, Arbor Drive, San Diego, CA, 92103-8681, USA.
AIDS Res Ther. 2013 Mar 28;10(1):9. doi: 10.1186/1742-6405-10-9.
Access to Hepatitis C (HCV) care is low among HIV-infected individuals, highlighting the need for new models to deliver care for this population.
Retrospective cohort analysis that compared the number of HIV patients who initiated HCV therapy: hepatology (2005-2008) vs. HIV primary care model (2008-2011). Logistic-regression modeling was used to ascertain factors associated with HCV therapy initiation and achievement of sustained viral response (SVR).
Of 196 and 163 patients that were enrolled in the HIV primary care and hepatology models, 48 and 26 were treated for HCV, respectively (p = 0.043). The HIV/HCV-patient referral rate did not differ during the two study periods (0.10 vs. 0.12/patient-yr, p = 0.18). In unadjusted analysis, predictors (p < 0.05) of HCV treatment initiation included referral to the HIV primary care model (OR: 1.7), a CD4+ count ≥400/mm3 (OR: 1.8) and alanine aminotranferase level ≥63U/L (OR: 1.9). Prior psychiatric medication use correlated negatively with HCV treatment initiation (OR: 0.6, p = 0.045). In adjusted analysis the strongest predictor of HCV treatment initiation was CD4+ count (≥400/mm3, OR: 2.1, p = 0.01). There was no significant difference in either clinic model (primary care vs. hepatology) in the rates of treatment discontinuation due to adverse events (29% vs. 16%), loss to follow-up (8 vs. 8%), or HCV SVR (44 vs. 35%).
Using a HIV primary care model increased the number of HIV patients who initiate HCV therapy with comparable outcomes to a hepatology model.
在感染 HIV 的个体中，获得丙型肝炎（HCV）治疗的机会较低，这突出表明需要新的模式来为这一人群提供治疗。
对比较了两种模型（2005-2008 年的肝病学模型和 2008-2011 年的 HIV 初级保健模型）中开始 HCV 治疗的 HIV 患者数量的回顾性队列分析。使用逻辑回归模型确定与 HCV 治疗启动和持续病毒学应答（SVR）相关的因素。
在纳入 HIV 初级保健和肝病学模型的 196 名和 163 名患者中，分别有 48 名和 26 名接受 HCV 治疗（p=0.043）。在两个研究期间，HIV/HCV 患者的转介率没有差异（0.10 与 0.12/患者-年，p=0.18）。在未调整分析中，HCV 治疗启动的预测因素（p<0.05）包括转介至 HIV 初级保健模型（比值比[OR]：1.7）、CD4+计数≥400/mm3（OR：1.8）和丙氨酸氨基转移酶水平≥63U/L（OR：1.9）。先前使用精神科药物与 HCV 治疗启动呈负相关（OR：0.6，p=0.045）。在调整分析中，HCV 治疗启动的最强预测因素是 CD4+计数（≥400/mm3，OR：2.1，p=0.01）。在初级保健与肝病学两种临床模型中，由于不良事件（29%与 16%）、失访（8%与 8%）或 HCV SVR（44%与 35%）而导致的治疗中断率均无显著差异。
使用 HIV 初级保健模型增加了开始 HCV 治疗的 HIV 患者数量，并且与肝病学模型的结果相当。
