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 19 January 2018

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Predicting Hep C treatment in US veterans coinfected with HIV

Well-controlled HIV is the most important factor affecting the receipt of Hep C treatment in coinfected veterans, shows the latest Journal of Viral Hepatitis.

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The US Department of Veterans Affairs cares for many human immunodeficiency virus/Hepatitis C virus-coinfected patients.

Veterans Affairs treatment recommendations indicate that all HIV/Hepatitis C-coinfected patients undergo evaluation for Hepatitis C treatment.

The Veterans Affairs also list pretreatment assessment tests.

Dr Lisa Backus and colleagues from California compared clinical practice with these recommendations.

The research team identified 377 HIV/Hepatitis C-coinfected veterans who began Hepatitis C therapy with pegylated interferon and ribavirin.

The research team also evaluated 4135 HIV/Hepatitis C-coinfected veterans who did not but were in Veterans Affairs care facilities during the same period.

The researchers compared laboratory and clinical characteristics of the 2 groups.

The team estimated multivariate logistic regression models of receipt of Hepatitis C treatment.

Lower creatinines predicted Hep C treatment
Journal of Viral Hepatitis

Overall, patients had high rates of receipt of tests necessary for Hepatitis C pretreatment assessment.

The researchers noted that patients starting Hepatitis C treatment had higher alanine aminotransferase levels.

The patients also had lower creatinine, higher CD4 counts and lower HIV viral loads than patients not starting Hepatitis C treatment.

In the multivariate model, the team noted that positive predictors of starting Hepatitis C treatment included being non-Hispanic whites.

Having higher alanine aminotransferase, lower creatinines, higher Hepatitis C viral loads, and higher CD4 counts predict starting Hepatitis C treatment.

The researchers found that undetectable HIV viral loads and receiving HIV antiretrovirals predict starting Hepatitis C treatment.

The team noted that a history of chronic mental illness, and a history of hard drug use were negative predictors.

Most HIV/Hepatitis C-coinfected patients received the necessary Hepatitis C pretreatment assessments.

However, the rates of screening for Hepatitis A and B immunity can be improved.

Dr Backus' team concludes, “Having well-controlled HIV disease is by far the most important modifiable factor affecting the receipt of Hepatitis C treatment.”

“More research is needed to determine if the observed racial differences in starting Hepatitis C treatment reflect biological differences, provider behaviour or patient preference.”

J Vir Hep 2006: 13(12): 799
16 November 2006

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