UCSF

Background: Hepatitis C (HCV) infection is reported in approximately 30% of HIV infected patients. Treatment of HCV is crucial to prevent liver decompensation and/or liver failure; however, rates of HCV treatment in this patient population are extremely low. Referral rates for HCV evaluation range from 10-40%, with initiation of therapy at <20%.

Purpose: To determine the patient factors associated with liver disease referral and evaluation for hepatitis C treatment in a cohort of HIV/HCV coinfected individuals.

Methods: A retrospective cohort study was conducted to collect patient demographics, HIV and HCV disease severity, major medical comorbidities, mental health status, substance use, and social context from a group of adult HIV/HCV coinfected individuals seen at a large university based HIV clinic from January 1, 2003 to December 31, 2006. Descriptive statistics, univariate and multivariate logistic regression determined group differences between those referred for HCV evaluation with those not referred, and between those referred for HCV evaluation who attended their appointment with the group that was nonadherent to liver evaluation.

Findings: A cohort of 538 HIV/HCV coinfected patients were analyzed for this study. A total of 308 patients (57%) were referred for liver disease evaluation by their HIV provider. In the referred group, 224 patients were seen and evaluated for possible HCV treatment, of which 79 patients went on to receive HCV treatment. Of those patients referred, 84 patients did not attend their liver disease clinic appointment. No referral was received in 230 HIV/HCV coinfected patients. In the analysis between the HIV/HCV coinfected patients referred for evaluation with those not referred, significant differences were found in liver disease severity, cardiac disease, history of skin cancer, antiretroviral therapy use, psychiatric evaluation, current substance use, homelessness, and history of incarceration. Factors that remained significant in the multivariate analysis included liver disease markers, homelessness, and incarceration. For those patients who did not attend liver disease evaluation, differences included age, cirrhosis, current substance use, incarceration, psychiatric evaluation, and nonadherence to HIV medications and/or visits, with only incarceration and psychiatric evaluation remaining significant in multivariate analysis.