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.”