Marseille 2007
| Abstract #484 - Social Scientific Aspects of the Treatment of Hepatitis C in HIV-positive persons | ||||
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Session: 36.6: Prevention lessons (Parallel) on Tuesday @ 14.00-16.00 in 5 Chaired by Theo Sandfort, William Zule Authors: Presenting Author: Dr Jeffrey Weiss - Mount Sinai School of Medicine, United States |
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| Additional Authors: Dr Dawn Fishbein, | ||||
| Aim: To discuss the key social scientific aspects of the treatment of Hepatitis C virus (HCV) in HIV-positive persons: (1) barriers to accessing HCV treatment; (2) assessment of adherence to HCV treatment; (3) determinants of early HCV treatment discontinuation; (4) HCV adherence-resistance relationships; (5) HCV adherence-outcome relationships; (6) interventions to improve adherence to HCV treatment. | ||||
| Method / Issue: Coinfection with HIV hastens the progression of liver disease in persons with HCV. As mortality directly due to HIV continues to decrease in developed countries among HIV-positive persons on fully suppressive antiretroviral regimens, coinfection with HCV has emerged as a leading cause of death. There is increasing attention to the need to actively treat HCV infection in HIV/HCV coinfected patients. Current HCV treatment with pegylated interferon and ribavirin achieves sustained viral response in up to 40% of coinfected patients, but has numerous hematologic, physical, and neuropsychiatric side effects. Providers are hesitant to begin HCV treatment in the coinfected population given the high prevalence of existing psychiatric illness, cognitive impairment, and substance use disorders. There is an urgent need for research into the psychiatric and behavioral predictors of HCV treatment adherence and virological outcome, as well as into the optimal psychiatric management of the neuropsychiatric sequelae of HCV therapy. | ||||
| Results / Comments: An on-site coinfection clinic was started in October 2005 within a large HIV clinic in New York City serving a predominantly minority, educationally and economically disadvantaged patient population. The mission of the coinfection clinic is to provide integrated medical services, improve engagement in and access to complete medical care, and decrease overall morbidity and mortality in HIV/HCV coinfection. Integrated medical provider services include a dedicated nurse practitioner, psychiatrist, psychologist, ID/HIV specialist and a hepatologist. Several research studies have begun in the HIV/HCV coinfected patients on HCV therapy to determine levels of adherence to HCV therapy, prescriber use of psychotropic medication to manage the neuropsychiatric side effects of HCV therapy, and the psychosocial determinants of adherence to HCV therapy and early HCV treatment discontinuation. | ||||
| Discussion: As the treatment of HCV continues to evolve and new classes of agents are introduced such as HCV RNA protease and polymerase inhibitors, issues of resistance developing due to missed doses of medication will become a much larger issue. Adherence to HCV treatment will also become more difficult as some of these new agents may require three times daily dosing. While the assessment of adherence to ARV medication has been widely integrated into HIV patient care, the assessment of adherence has not reached the same level of integration in HCV clinical care. The co-location of HCV treatment services within an HIV clinic can successfully increase the rates of referral for and initiation of HCV treatment in coinfected patients, provide a multidisciplinary approach to the treatment of HCV in coinfected patients, and allow for social scientific research on HCV treatment in coinfected patients to be conducted. | ||||
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