Hepatitis C Care Continuum in a Human Immunodeficiency Virus (HIV) Positive Cohort: Data From the HIV Atlanta Veterans Affairs Cohort Study

• Type of Material: Article
• Authors: Ruth O. Adekunle, Emory University; Kathryn DeSilva, Atlanta VA Medical Center; Emily Cartwright, Emory University
• Language: English
• Date: 2020-04-01
• Publisher: Oxford University Press
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/ofid/ofaa085
• Title of Journal or Parent Work: Open Forum Infectious Diseases
• Volume: 7
• Issue: 4
• Start Page: ofaa085
• End Page: ofaa085
• Grant/Funding Information: Our research activities are funded, in part, by grants from the National Institutes of Health/National Center for Advancing Translational Sciences (TL1TR002382, UL1TR002378).
• Keywords: Microbiology; Science & Technology; chronic hepatitis C virus; Disorders; US veterans; Life Sciences & Biomedicine; Immunology; Infectious Diseases; Elimination; care continuum; direct-acting antivirals; Liver diseases; veterans; human immunodeficiency virus
• Research Categories: Biology, Microbiology; Health Sciences, Immunology; Health Sciences, Epidemiology

Abstract

Background: Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) coinfection is associated with accelerated progression to cirrhosis, end-stage liver disease, and liver-associated death. It is fortunate that curative direct-acting antivirals for the treatment of HCV are widely available in the VA healthcare system. We attempted to identify, evaluate, and treat all HIV/HCVcoinfected persons at the Atlanta VA Healthcare System. Methods: Human immunodeficiency virus/HCV-coinfected persons at Atlanta VA between 2015 and 2018 were identified using the HIV Atlanta Veterans Affairs Cohort Study and Hepatitis C VA Clinical Case Registry. Retrospective reviews of each electronic medical record were conducted by the hepatitis C clinical team for validation. The primary end point was achieving sustained virologic response. Results: One hundred thirty-eight veterans with HIV and hepatitis C viremia were identified. One hundred twenty-five (90%) were evaluated for treatment and 113 (91%) were initiated on direct-acting antiviral therapy. Median age at initiation of treatment was 60 years and the majority were black race (90%). Genotype 1a was most common (70%) and 41% had compensated cirrhosis. One hundred eight completed treatment and 96% achieved sustained virologic response. Six veterans had virologic relapse; 4 had treatment-emergent resistance mutations in the NS5a gene. Mean CD4 was 580 cells/mm3 with HIV viral suppression in 82% of the cohort. In those not treated, unstable housing (25%), active substance use (31%), and psychiatric conditions (42%) were identified barriers to care. Conclusions: Through a concerted, systematic effort, over 80% of HIV/hepatitis C persons in the Atlanta VA have been initiated on treatment for hepatitis C, 96% of which have been cured.