Race, Gender Significant Predictors of Failure to Treat Hepatitis C Virus-related Liver Disease in Patients Co-infected with HIV

Gender, race, and active substance abuse were among the factors that significantly predicted whether patients with a human immunodeficiency virus (HIV) and HCV co-infection sought treatment for Hepatitis C virus (HCV)-related liver disease, according to a recent study.

These findings were presented by Guajira Thomas, MD, and colleagues from the Northwestern University School of Medicine on October 3, 2013, at IDWeek 2013, a joint meeting of the Infectious Diseases Society of America (IDSA), the Society for Healthcare Epidemiology of America (SHEA), the HIV Medicine Association (HIVMA), and the Pediatric Infectious Diseases Society (PIDS), in San Francisco, CA.

Hepatitis C virus (HCV)-related liver disease is a major cause of morbidity and mortality in patients with HIV, according to the researchers. HCV has a similar mode of transmission as HIV, and the progression of HCV is often accelerated in patients with HIV, according to a previous meta-analysis. Antiviral therapy for HCV may reduce the progression of the disease. However, patients often face barriers to obtaining proper treatment for HCV, including psychosocial issues and medical co-morbidities.

The current study investigated demographics and clinical characteristics, and possible barriers to HCV treatment, of 109 HIV patients with a chronic HCV infection from the Northwestern University Viral Hepatitis Registry (NU-VHR) and HIV Outpatient Study (N-HOPS) prospective cohorts. Fifty (46%) of these patients received HCV treatment, with 44 of these 50 patients being male. The treatment group had a significantly higher proportion (88%) of males compared to the non-treatment group (71%), suggesting that gender was a significant predictor of whether an individual received HCV treatment. However, a larger number of women should be analyzed to confirm this gender bias, according to Thomas.

Race was also a significant predictor of treatment status. African-Americans were less likely to receive treatment, as they comprised 22% of the treatment group compared to 50.8% of the non-treatment group. By contrast, Caucasian patients made up 66% of the treatment group and 32.2% of the non-treatment group.

HIV parameters, including the duration of HIV infection, CD4 + lymphocyte count, presence of AIDS, HIV RNA levels, and regimen type, were also analyzed in relation to patient treatment. Thomas and colleagues found that individuals with AIDS were significantly less likely to obtain HCV therapy, whereas individuals on a NNRTI-containing regimen were more likely to obtain therapy.

The researchers did not find a relationship between infection risk factors, such as recreational drug use, hemophilia, or sexual behaviors, and the likelihood of seeking HCV treatment.

However, Thomas noted that the results of the current study were assessed using univariate analysis, or by analyzing each individual variable separately. According to the researchers, future studies should use multivariate analysis to confirm the race and gender associations to the failure to treat HCV, taking into account infection risk factors and HIV parameters that may be more prevalent in a certain demographic. Thomas also noted that an infectious disease-centered HCV therapy may provide a more convenient option for patients by improving their relationship with the treatment provider and reducing the number of medical evaluations.

All authors listed financial disclosures.