Hepatitis C treatment uptake and response among human immunodeficiency virus/hepatitis C virus-coinfected patients in a large integrated healthcare system

Author:

Lam Jennifer O1ORCID,Hurley Leo B1,Chamberland Scott2,Champsi Jamila H3,Gittleman Laura C4,Korn Daniel G5,Lai Jennifer B6,Quesenberry Charles P1,Ready Joanna7,Saxena Varun3,Seo Suk I89,Witt David J6,Silverberg Michael J1,Marcus Julia L10

Affiliation:

1. Kaiser Permanente Division of Research, Oakland, CA, USA

2. Kaiser Permanente Northern California, Regional Pharmacy, Oakland, CA, USA

3. Kaiser Permanente South San Francisco Medical Center, South San Francisco, CA, USA

4. Kaiser Permanente Northern California, Medical Group Support Services, Oakland, CA, USA

5. Kaiser Permanente Oakland Medical Center, Oakland, CA, USA

6. Kaiser Permanente San Rafael Medical Center, San Rafael, CA, USA

7. Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA, USA

8. Kaiser Permanente Antioch Medical Center, Antioch, CA, USA

9. Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, CA, USA

10. Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA

Abstract

U.S. guidelines recommend that patients coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) be prioritized for HCV treatment with direct-acting antiviral agents (DAAs), but the high cost of DAAs may contribute to disparities in treatment uptake and outcomes. We evaluated DAA initiation and effectiveness in HIV/HCV-coinfected patients in a U.S.-based healthcare system during October 2014–December 2017. Of 462 HIV/HCV-coinfected patients, 276 initiated DAAs (70% cumulative proportion treated over three years). Lower likelihood of DAA initiation was observed among patients with Medicare (government-sponsored insurance) versus commercial insurance (adjusted rate ratio [aRR] = 0.62, 95% CI = 0.46–0.84), patients with drug abuse diagnoses (aRR = 0.72, 95% CI = 0.54–0.97), patients with CD4 cell count <200 cells/µl versus ≥500 (aRR = 0.45, 95% CI = 0.23–0.91), and patients without prior HCV treatment (aRR = 0.68, 95% CI = 0.48–0.97). There were no significant differences in DAA initiation by age, gender, race/ethnicity, socioeconomic status, HIV transmission risk, alcohol use, smoking, fibrosis level, HIV RNA levels, antiretroviral therapy use, hepatitis B infection, or number of outpatient visits. Ninety-five percent of patients achieved sustained virologic response (SVR). We found little evidence of sociodemographic disparities in DAA initiation among HIV/HCV-coinfected patients, and SVR rates were high. Efforts are needed to increase DAA uptake among coinfected Medicare enrollees, patients with drug abuse diagnoses, patients with low CD4 cell count, and patients receiving first-time HCV treatment.

Funder

National Institute of Allergy and Infectious Diseases

Kaiser Permanente Northern California Delivery Science Research Program

Publisher

SAGE Publications

Subject

Infectious Diseases,Pharmacology (medical),Public Health, Environmental and Occupational Health,Dermatology

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