Limited effectiveness of antiviral treatment for hepatitis C in an urban HIV clinic

Shruti H. Mehta, Gregory M. Lucas, Lisa B. Mirel, Michael Torbenson, Yvonne Higgins, Richard D. Moore, David L. Thomas, Mark S. Sulkowski

Research output: Contribution to journalArticle

107 Scopus citations

Abstract

OBJECTIVE: To evaluate predictors and trends of referral for hepatitis C virus (HCV) care, clinic attendance and treatment in an urban HIV clinic. DESIGN AND METHODS: A retrospective cohort analysis in which 845 of 1318 co-infected adults who attended the Johns Hopkins HIV clinic between 1998 and 2003 after an on-site viral hepatitis clinic was opened, attended regularly (≥ 1 visit/year for ≥ 2 years). Logistic regression was used to examine predictors of referral. RESULTS: A total of 277 (33%) of 845 were referred for HCV care. Independent predictors of referral included percentage elevated alanine aminotransferase levels [adjusted odds ratio (AOR) for 10% increase,1.16; 95% confidence interval (CI), 1.10-1.22] and CD4 cell count > 350 cells/μl (AOR, 3.20; 95% CI, 2.10-4.90), while injection drug use was a barrier to referral (AOR, 0.26; 95% CI, 0.11-0.64). Overall referral rate increased from < 1% in 1998 to 28% in 2003; however, even in 2003, 65% of those with CD4 cell count > 200 cells/μl were not referred. One hundred and eighty-five (67%) of 277 referred kept their appointment, of whom 32% failed to complete a pre-treatment evaluation. Of the remaining 125, only 69 (55%) were medically eligible for treatment, and 29 (42%) underwent HCV treatment. Ninety percent of 29 were infected with genotype 1 and 70% were African American; six (21%) achieved sustained virologic response (SVR). Only 0.7% of the full cohort achieved SVR. CONCLUSIONS: Although the potential for SVR and the recent marked increase in access to HCV care are encouraging, overall effectiveness of anti-HCV treatment in this urban, chiefly African American, HCV genotype 1 HIV clinic is extremely low. New therapies and treatment strategies are an urgent medical need.

Original languageEnglish (US)
Pages (from-to)2361-2369
Number of pages9
JournalAIDS
Volume20
Issue number18
DOIs
StatePublished - Nov 2006

Keywords

  • Antiviral therapy
  • HIV
  • Hepatitis C
  • Intravenous drug abuse
  • Referral

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

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  • Cite this

    Mehta, S. H., Lucas, G. M., Mirel, L. B., Torbenson, M., Higgins, Y., Moore, R. D., Thomas, D. L., & Sulkowski, M. S. (2006). Limited effectiveness of antiviral treatment for hepatitis C in an urban HIV clinic. AIDS, 20(18), 2361-2369. https://doi.org/10.1097/QAD.0b013e32801086da