The rate of treatment of chronic hepatitis C in patients co‐infected with HIV in an urban medical centre

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Abstract
Summary. Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) co‐infection is common. HIV co‐infection results in a higher rate of histologic progression and shorter interval to HCV‐related cirrhosis. Successful treatment of HCV with interferon‐based therapy reduces the morbidity and mortality of patients. Significant factors may limit the availability of treatment in co‐infected patients. The rate of treatment of HCV and limiting factors to treatment in a co‐infected population in an urban setting were determined. A retrospective review of co‐infected patients was conducted at our liver and gastrointestinal (GI) clinics for treatment of HCV from July 2001 to June 2002. Treatment of HCV and reasons for nontreatment were recorded. A total of 104 HCV/HIV co‐infected patients were identified. Seventy‐two per cent were males. Mean age was 47.2 years (32–72). Seventy‐four of the 82 (90%) with identifiable risk factors for HCV infection had a history of intravenous drug use (IVDU). Twenty per cent (21/104) of the total underwent a liver biopsy. Sixty‐seven per cent who had a liver biopsy were treated. Overall, sixteen patients were treated. Eighty‐eight (85%) patients were not treated for the following reasons: 13 refused treatment, and 75 were ineligible. Of the ineligible patients, 40% were noncompliant with visits, 15% were active substance abusers, 13% had decompensated cirrhosis, 8% had significant active psychiatric conditions and 24% had significant co‐morbid disease. A majority of patients co‐infected with HCV/HIV had a IVDU history. Most co‐infected patients were not eligible for HCV treatment. A majority of noncandidates had potentially modifiable psychosocial factors leading to nontreatment.