Department of Biology, Morgan State University, Baltimore, Maryland, USA.
Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
BMJ Open. 2019 Mar 30;9(3):e027411. doi: 10.1136/bmjopen-2018-027411.
Little is known about the cascade of hepatitis C care among HIV/hepatitis C virus (HCV)-coinfected patients in community-based clinics. Thus, we analysed our data from the interferon era to understand the barriers to HCV treatment, which may help improve getting patients into treatment in the direct-acting antivirals era.
Retrospective cohort study.
Four HIV clinics of a multisite community health centre in the USA.
1935 HIV-infected men with >1 medical visit to the clinic between 2011 and 2013. Of them, 371 had chronic HCV and were included in the analysis for HCV care continuum during 2003-2014.
HCV treatment initiation was designated as the primary outcome for analysis. Multivariate logistic regression was performed to identify factors associated with HCV treatment initiation.
Among the 371 coinfected men, 57 (15%) initiated HCV treatment. Entering care before 2008 (adjusted OR [aOR, 3.89; 95% CI, 1.95 to 7.78), higher educational attainment (aOR, 3.20; 95% CI, 1.59 to 6.44), HCV genotype 1 versus non-1 (aOR, 0.21; 95% CI, 0.07 to 0.65) and HIV suppression (aOR, 2.13; 95% CI, 1.12 to 4.06) independently predicted treatment initiation. Stratification by entering care before or after 2008 demonstrated that higher educational attainment was the only factor independently associated with treatment uptake in both periods (aOR, 2.79; 95% CI, 1.13 to 6.88 and aOR, 4.10; 95% CI, 1.34 to 12.50, pre- and post-2008, respectively). Additional associated factors in those entering before 2008 included HCV genotype 1 versus non-1 (aOR, 0.09; 95% CI, 0.01 to 0.54) and HIV suppression (aOR, 2.35; 95% CI, 1.04 to 5.33).
Some traditional barriers predicted HCV treatment initiation in those in care before 2008; however, the patients' level of educational attainment remained an important factor even towards the end of the interferon era. Further studies will need to determine whether educational attainment persists as an important determinant for initiating direct-acting antiviral therapies.
在社区诊所中，对 HIV/丙型肝炎病毒 (HCV) 合并感染患者的丙型肝炎治疗级联反应知之甚少。因此，我们对干扰素时代的数据进行了分析，以了解 HCV 治疗的障碍，这可能有助于改善直接作用抗病毒药物时代患者接受治疗的情况。
回顾性队列研究。
美国一家多地点社区卫生中心的 4 个 HIV 诊所。
2011 年至 2013 年间，1935 名 HIV 感染男性在诊所就诊超过 1 次。其中，371 名患有慢性 HCV，被纳入 2003-2014 年 HCV 护理连续体的分析。
HCV 治疗开始被指定为分析的主要结局。采用多变量逻辑回归来确定与 HCV 治疗开始相关的因素。
在 371 名合并感染的男性中，有 57 名（15%）开始 HCV 治疗。2008 年前进入治疗（调整后的比值比 [aOR]，3.89；95%CI，1.95 至 7.78）、教育程度较高（aOR，3.20；95%CI，1.59 至 6.44）、HCV 基因型 1 与非 1（aOR，0.21；95%CI，0.07 至 0.65）和 HIV 抑制（aOR，2.13；95%CI，1.12 至 4.06）独立预测治疗开始。按 2008 年前或后进入治疗进行分层表明，在两个时期，较高的教育程度是与治疗采用相关的唯一因素（2008 年前：aOR，2.79；95%CI，1.13 至 6.88；aOR，4.10；95%CI，1.34 至 12.50；2008 年后：aOR，2.79；95%CI，1.13 至 6.88；aOR，4.10；95%CI，1.34 至 12.50）。2008 年前进入治疗的其他相关因素包括 HCV 基因型 1 与非 1（aOR，0.09；95%CI，0.01 至 0.54）和 HIV 抑制（aOR，2.35；95%CI，1.04 至 5.33）。
在 2008 年前接受治疗的患者中，一些传统的障碍预测了 HCV 治疗的开始；然而，即使在干扰素时代结束时，患者的教育程度仍然是一个重要因素。进一步的研究将需要确定教育程度是否仍然是启动直接作用抗病毒疗法的重要决定因素。
