Published online Mar 8, 2016. doi: 10.4254/wjh.v8.i7.368
Peer-review started: August 3, 2015
First decision: September 14, 2015
Revised: October 24, 2015
Accepted: December 3, 2015
Article in press: December 4, 2015
Published online: March 8, 2016
AIM: To assess whether reasons for hepatitis C virus (HCV) therapy non-initiation differentially affect racial and ethnic minorities with human immunodeficiency virus (HIV)/HCV co-infection.
METHODS: Analysis included co-infected HCV treatment-naïve patients in the University of North Carolina CFAR HIV Clinical Cohort (January 1, 2004 and December 31, 2011). Medical records were abstracted to document non-modifiable medical (e.g., hepatic decompensation, advanced immunosuppression), potentially modifiable medical (e.g., substance abuse, severe depression, psychiatric illness), and non-medical (e.g., personal, social, and economic factors) reasons for non-initiation. Statistical differences in the prevalence of reasons for non-treatment between racial/ethnic groups were assessed using the two-tailed Fisher’s exact test. Three separate regression models were fit for each reason category. Odds ratios and their 95%CIs (Wald’s) were computed.
RESULTS: One hundred and seventy-one patients with HIV/HCV co-infection within the cohort met study inclusion. The study sample was racially and ethnically diverse; most patients were African-American (74%), followed by Caucasian (19%), and Hispanic/other (7%). The median age was 46 years (interquartile range = 39-50) and most patients were male (74%). Among the 171 patients, reasons for non-treatment were common among all patients, regardless of race/ethnicity (50% with ≥ 1 non-modifiable medical reason, 66% with ≥ 1 potentially modifiable medical reason, and 66% with ≥ 1 non-medical reason). There were no significant differences by race/ethnicity. Compared to Caucasians, African-Americans did not have increased odds of non-modifiable [adjusted odds ratio (aOR) = 1.47, 95%CI: 0.57-3.80], potentially modifiable (aOR = 0.72, 95%CI: 0.25-2.09) or non-medical (aOR = 0.90, 95%CI: 0.32-2.52) reasons for non-initiation.
CONCLUSION: Race/ethnicity alone is not predictive of reasons for HCV therapy non-initiation. Targeted interventions are needed to improve access to therapy for all co-infected patients, including minorities.
Core tip: Historically, hepatitis C virus (HCV) treatment rates have been low in patients with human immunodeficiency virus (HIV) co-infection, especially for African-American patients. Identifying the reasons for treatment non-initiation may help improve treatment rates among racially and ethnic minorities. In our study of patients with HIV/HCV coinfection, non-modifiable medical reasons, potentially modifiable medical reasons, and non-medical reasons for non-treatment were common among all patients, regardless of their race/ethnicity. There is a need to recognize and overcome potential treatment barriers in order to improve HCV treatment uptake in this patient population.