Research Article: Patient Characteristics Associated with HCV Treatment Adherence, Treatment Completion, and Sustained Virologic Response in HIV Coinfected Patients

Date Published: October 26, 2011

Publisher: Hindawi Publishing Corporation

Author(s): Glenn Wagner, Karen Chan Osilla, Jeffrey Garnett, Bonnie Ghosh-Dastidar, Laveeza Bhatti, Matthew Bidwell Goetz, Mallory Witt.


Background. Hepatitis C (HCV) treatment efficacy among HIV patients is limited by poor treatment adherence and tolerance, but few studies have examined the psychosocial determinants of treatment adherence and outcomes. Methods. Chart abstracted and survey data were collected on 72 HIV patients who had received pegylated interferon and ribavirin to assess correlates of treatment adherence, completion, and sustained virologic response (SVR). Results. Nearly half (46%) the sample had active psychiatric problems and 13% had illicit drug use at treatment onset; 28% reported <100% treatment adherence, 38% did not complete treatment (mostly due to virologic nonresponse), and intent to treat SVR rate was 49%. Having a psychiatric diagnosis was associated with nonadherence, while better HCV adherence was associated with both treatment completion and SVR. Conclusions. Good mental health may be an indicator of HCV treatment adherence readiness, which is in turn associated with treatment completion and response, but further research is needed with new HCV treatments emerging.

Partial Text

Over 30% of all HIV patients are estimated to be coinfected with hepatitis C virus (HCV), and liver disease is now a leading cause of death in this population [1–3]. Yet very few (<10%) coinfected patients actually receive HCV therapy [4–7], in part because of limited treatment efficacy and anticipated difficulty with treatment adherence. The advent of pegylated-interferon (PEG-IFN) therapy in combination with ribavirin (RBV) has led to dramatic improvements in the efficacy of HCV treatment, but response rates remain limited, particularly among coinfected patients; sustained virologic response (SVR), defined as an undetectable HCV viral load six months after the completion of treatment, is roughly 20–45% among coinfected patients [8–13], and is inversely associated with severity of immune suppression [14]. We enrolled a sample of 173 patients in the study, of whom 127 (73%) had been offered HCV treatment at some point, and 72 (42%) had received PEG-IFN/RBV treatment (7 others were about to start treatment; 48 patients who had been recommended treatment, opted to refuse or defer it). Findings regarding factors associated with provider recommendation of treatment [31], and patient acceptance and initiation of treatment [32], have been reported elsewhere. In this paper we report analyses on the data from the subgroup of 72 treated patients. Slightly over 40% of our sample had received HCV treatment, a much higher rate than treatment rates reported in other studies of HIV coinfected patients [4–7], in part because our rates reflect lifetime history of treatment whereas many other studies report an evaluation of treatment eligibility and initiation at a single time point. With the significant proportion of the sample having received HCV treatment, we were able to examine the frequency and correlates of treatment adherence, completion and virologic response.   Source: