Epidemiology

HCV infection rarely treated in poor HIV-coinfected patients in San Francisco

Last Updated: 2004-04-02 11:42:41 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Findings from a new study indicate that 73.1% of poor HIV-infected patients living in San Francisco are also infected with hepatitis C virus (HCV). While about half of these patients are receiving antiretroviral agents, less than 4% are taking any medications for the HCV infection.

"San Francisco, like most urban centers, simply has not risen to the challenge of making HCV therapy available in the same way it made HIV therapy available in the 80s and 90s," lead author Dr. Christopher S. Hall, from the University of California at San Francisco, said in a statement.

As reported in the Journal of General Internal Medicine for April, Dr. Hall's team assessed HCV infection and treatment in 249 members of the REACH Cohort, a sample of HIV-infected patients identified from homeless shelters, single-room occupancy hotels, and free lunch programs in San Francisco.

Eighty-two percent of the subjects were male, 43% were African-American, and 64% were lifetime injection drug users, the investigators report. Another 24% were living in a shelter or on the street in the past month. Forty-eight percent of patients were being treated with antiretroviral therapy.

At baseline, the prevalence of HCV positivity was 69.1%. During a median follow-up period of 28.9 months, this rate increased to 73.1%.

Sixty-two percent of patients had HCV-viremia. The rate of HCV antibody-negative HCV-viremia was 13.2%, the authors state.

Predictors of HCV infection included injection drug use, elevated ALT level, homelessness in the last year, and more severe depressive symptoms, the investigators note. The rates of new HCV infection in the overall cohort and among injection drug users were 4.63% and 16.77% per person-year, respectively.

After controlling for drug use and other confounders, nonwhite patients were less likely than others to receive HCV testing and subspecialty referral. Nearly 70% of HCV-positive patients knew treatment was available, but only 3.8% actually received anti-HCV therapy.

"One of the limitations of this study is the inability to identify those patients clearly needing treatment for hepatitis C. Only 21% of the coinfected patients had been referred to a liver specialist who could make that determination," Dr. Hall pointed out.

J Gen Intern Med 2004;19:357-365.