Researchers from the Michael E.
DeBakey VA Medical Center, led by Jennifer Kramer, Ph.D., looked at a
population of U.S. veterans to determine the patient, provider, and
facility characteristics that determined how likely after diagnosis for
hepatitis C virus patients who have HIV are treated for HCV. This
retrospective study used the Hepatitis C Clinical Case Registry to identify
patients who had both infections and who had visited a VA facility at least
twice in a six-year period. "This is a very large cohort (N=7,103) of
patients with laboratory confirmed HCV-HIV coinfection (maybe one of the
largest ever examined) that is very representative of VA users," said Dr.
Kramer, but she cautions, "It is difficult to draw conclusions to all
patients with HCV-HIV coinfection because the VA cohort tends to be
predominately male and relatively low income."
Of those patients in the registry who had HCV and HIV, 10.3% were
treated within two years of HCV diagnosis. The researchers went on to
identify the factors that resulted in treatment for those patients. Race
was a patient factor that determined who was more likely to be treated for
HCV. Patients who were black or Hispanic were not as likely to be treated
as compared to white patients after HCV diagnosis. Other determining
factors were sex (males weren't as likely to be treated as females), drug
use, psychosis, high HIV viral load, and genotype 1 or 4. Patients were
more likely to be treated if they were diagnosed with HCV more recently;
were also diagnosed with cirrhosis; and had high CD4 counts, hemoglobin,
and persistently high liver enzyme scores.
The study's authors also identified provider and facility
characteristics that determined if a patient who also had HIV was treated
for HCV. Patients were more likely to be treated if the facility in which
they were seen had only one inpatient hospital compared to those with
multiple sites and if the provider was a specialist for HCV.
"The study highlights the important role of facilities and providers,
in addition to the known patient-related factors, in explaining variation
and possibly outcomes of care in HCV-infected patients," said Hashem
El-Serag, MD. "These factors have been largely ignored in current research.
We plan to investigate the role of facility factors in HCV treatment
receipt in coinfected patients further by including data from a recently
completed facility survey addressing facility factors specifically involved
in HCV care."
Abstract title:
Patient, provider, and facility characteristics of HCV antiviral
treatment among US veterans with HCV-HIV coinfection.
AASLD is the leading medical organization for advancing the science and
practice of hepatology. Founded by physicians in 1950, AASLD's vision is to
prevent and cure liver diseases. This year's Liver Meeting, held in San
Francisco, California, October 31 - November 4, will bring together more
than 7,000 researchers from 55 countries.
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