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- Title
Direct-Acting Antiviral Hepatitis C Treatment Cascade and Barriers to Treatment Initiation Among US Men and Women With and Without HIV.
- Authors
Haley, Danielle F; Edmonds, Andrew; Ramirez, Catalina; French, Audrey L; Tien, Phyllis; Thio, Chloe L; Witt, Mallory D; Seaberg, Eric C; Plankey, Michael W; Cohen, Mardge H; Adimora, Adaora A
- Abstract
<bold>Background: </bold>People with HIV are disproportionately coinfected with hepatitis C virus (HCV) and experience accelerated liver-related mortality. Direct-acting antivirals (DAAs) yield high sustained virologic response (SVR) rates, but uptake is suboptimal. This study characterizes the DAA-era HCV treatment cascade and barriers among US men and women with or at risk for HIV.<bold>Methods: </bold>We constructed HCV treatment cascades using the Women's Interagency HIV Study (women, 6 visits, 2015-2018, n = 2447) and Multicenter AIDS Cohort Study (men, 1 visit, 2015-2018, n = 2221). Cascades included treatment-eligible individuals (ie, HCV RNA-positive or reported DAAs). Surveys captured self-reported clinical (eg, CD4), patient (eg, missed visits), system (eg, appointment access), and financial/insurance barriers.<bold>Results: </bold>Of 323/92 (women/men) treatment eligible, most had HIV (77%/70%); 69%/63% were black. HIV-positive women were more likely to attain cascade outcomes than HIV-negative women (39% vs 23% initiated, 21% vs 12% SVR); similar discrepancies were noted for men. Black men and substance users were treated less often. Women initiating treatment (vs not) reported fewer patient barriers (14%/33%). Among men not treated, clinical barriers were prevalent (53%).<bold>Conclusions: </bold>HIV care may facilitate HCV treatment linkage and barrier navigation. HIV-negative individuals, black men, and substance users may need additional support.<bold>Clinical Trials Registration: </bold>NCT00000797 (Women's Interagency HIV Study); NCT00046280 (Multicenter AIDS Cohort Study).
- Subjects
UNITED States; HEPATITIS C; CLINICAL trial registries; HIV; HEPATITIS C virus; ANTIVIRAL agents; HIV infection complications; HIV infections; RESEARCH; CHRONIC hepatitis C; RESEARCH methodology; HEPATITIS viruses; EVALUATION research; COMPARATIVE studies; MIXED infections; RESEARCH funding; HEALTH equity; AIDS; LONGITUDINAL method; DISEASE complications
- Publication
Journal of Infectious Diseases, 2021, Vol 223, Issue 12, p2136
- ISSN
0022-1899
- Publication type
journal article
- DOI
10.1093/infdis/jiaa686