Epidemiology

VA health system makes headway in HCV testing of HIV+ patients

Last Updated: 2003-05-22 16:55:52 -0400 (Reuters Health)

NEW YORK (Reuters Health) - The U.S. Department of Veterans Affairs (VA), recently identified hepatitis C virus (HCV) as a high-priority for improved detection and management among patients with HIV infection. According to a new study, the VA has made considerable progress in detection, but much less so in disease management.

Dr. Shawn L. Fultz from the VA Pittsburgh Healthcare System and colleagues examined testing, referral, and treatment patterns for HCV coinfection in a cohort of 881 veterans with HIV infection attending one of three VA medical centers. Forty-three percent were coinfected with HCV.

"Although VA healthcare providers appear to be testing most HIV-positive patients (80%) for HCV and are making efforts to address contraindications to antiviral treatment, very few patients are receiving antiviral therapy," they report in the April 15th issue of Clinical Infectious Diseases.

"Further, providers are largely unaware of current illicit drug and alcohol use and depression among their HCV-coinfected patients," they write.

Specifically, the team found that 30% of coinfected patients reported current alcohol use, which is known to accelerate the course of HCV, increase the risk of hepatocellular carcinoma and is a contraindication to antiviral therapy. Many physicians were unaware of their patients drinking habits and only one third of coinfected patients were counseled to reduce or quit drinking. Similar results were found for illicit drug use.

HCV/HIV-coinfected patients with indications for HCV therapy had a high rate of contraindications for antiviral treatment, including both medical and psychiatric comorbidities, a finding that confirms prior studies. (See Reuters Health report January 16, 2003.)

Of the 65 patients with indications for HCV therapy and no contraindications, only 18% underwent liver biopsy and only 3% received interferon.

The VA's emphasis on HCV infection make it a potentially "valuable laboratory in which to study current management issues and remaining barriers to treatment of coinfected patients," Dr. Fultz and colleagues write.

Clin Infect Dis 2003;36:1039-1045.