The objective of this study was to assess the prevalence of barriers to interferon treatment in a population of HIV/HCV coinfected patients. A cross-sectional study was conducted at two AIDS Outpatient Clinics in Brazil. The study included all HIV infected patients followed at these institutions from January 2005 to November 2007. Medical records of 2,024 HIV-infected patients were evaluated. The prevalence of anti-HCV positive patients among them was 16.7%. Medical records of HCV/HIV coinfected patients were analyzed. 189 patients with the following characteristics were included in our study: mean age 43 years; male gender 65%; former IDUs (52%); HCV genotype 1 (66.4%); HCV genotype 3 (30.5%); median CD4+ T cell count was 340 cells/mm3. Among 189 patients included in the analyses, only 75 (39.6%) were considered eligible for HCV treatment. The most frequent reasons for non-treatment were: non-compliance during clinical follow-up (31.4%), advanced HIV disease (21.9%), excessive alcohol consumption or active drug use (18.7%), and psychiatric disorders (10.1%). Conclusions: In Brazil, as in elsewhere, more than half of HIV/HCV coinfected patients (60.4%) have been considered not candidates to received anti-HCV treatment. The main reasons may be deemed questionable: non-adherence, drug abuse, and psychiatric disease. Our results highlight the importance of multidisciplinary teams to optimize the access of coinfected patients to HCV treatment.
Journal Information
Vol. 14. Issue 3.
Pages 237-241 (May - June 2010)
Vol. 14. Issue 3.
Pages 237-241 (May - June 2010)
Original article
Open Access
Barriers to treatment of hepatitis C in HIV/HCV coinfected adults in Brazil
Visits
2691
This item has received
Article information
Abstract
Keywords:
hepatitis C
HIV
coinfected
treatment
Full text is only aviable in PDF
References
[1.]
A. Treitinger, C. Spada, L.A. Ferreira, et al.
Hepatitis B and hepatitis C prevalence among blood donors and HIV-1 infected patients in Florianópolis-Brazil.
Braz J Infect Dis, 4 (2000), pp. 192-196
[2.]
M.C.J. Mendes-Corrêa, A.A. Barone, C. Guastini.
Hepatitis C virusseroprevalence and risk factors among patients with HIV infection.
Rev Inst Med Trop Sao Paulo, 43 (2001), pp. 15-19
[3.]
M.H. Pavan, F.H. Aoki, D.T. Monteiro, N.S.L. Gonçalves, C.A. Escanhoela, F.L. Gonçalves Junior.
Viral hepatitis in Patients infected with human immunodeficiency virus.
Braz J Infect Dis, 7 (2003), pp. 253-261
[4.]
M.R. Monteiro, M.M. Nascimento, A.D. Passos, J.F. Figueiredo, C. Hepatite.
Prevalência e fatores de risco entre portadores do VIH/SIDA em Belém. Pará, na Amazônia brasileira.
Rev Soc Bras Med Trop, 37 (2004), pp. 40-46
[5.]
A.C. Segurado, P. Braga, A. Etzel, M.R. Cardoso.
Hepatitis C virus coinfection in a cohort of HIV-infected individuals from Santos, Brazil: seroprevalence and associated factors.
AIDS Patient Care STDS, 18 (2004), pp. 135-143
[6.]
W.S. Braga, M. da Costa Castilho, I.C. dos Santos, M.A. Moura, A.C. Segurado.
Low prevalence of hepatitis B virus, hepatitis D virus and hepatitis C virus among patients with human immunodeficiency virus or acquired immunodeficiency syndrome in the Brazilian Amazon basin.
Rev Soc Bras Med Trop, 39 (2006), pp. 519-522
[7.]
C.V. Tovo, D.E. Dos Santos, A.Z. de Mattos, P.R. de Almeida, A.A. de Mattos, B.R. Santos.
Ambulatorial prevalence of hepatitis B and C markers in patients with human immunodeficiency virus infection in a general hospital.
Arq Gastroenterol, 43 (2006), pp. 73-76
[8.]
A.D. Mussi, R.A. Pereira, V. Corrêa e Silva, A. de, R.M. Martins, F.J. Souto.
Epidemiological aspects of hepatitis C virus infection among HIV-infected individuals in Mato Grosso State, Central Brazil.
Acta Trop, 104 (2007), pp. 116-121
[9.]
E.M. Reiche, A.M. Bonametti, H.K. Morimoto, et al.
Epidemiological, immunological and virological characteristics, and disease progression of HIV-1/HCV-co-infected patients from a southern Brazilian population.
Int J Mol Med, 21 (2008), pp. 387-395
[10.]
F.H. Carvalho, M.R. Coêlho, T. Vilella, A. de, J.L. Silva, H.R. Melo.
HIV/HCV coinfection at an university hospital in Recife, Brazil.
Rev Saúde Pública, 43 (2009), pp. 133-139
[11.]
D.B. Greco, M. Simão.
Brazilian policy of universal access to AIDS treatment: sustainability challenges and perspectives.
AIDS, 21 (2007), pp. S37-S45
[12.]
V. Soriano, M. Puoti, M. Sulkowski, et al.
Care of patients coinfected with HIV and hepatitis C virus: 2007 updated recommendations from the HCV-HIV International Panel.
AIDS, 21 (2007), pp. 1073-1089
[13.]
O.M. Adeyemi, D. Jensen, B. Attar, et al.
Hepatitis C treatment eligibility in an urban population with and without HIV coinfection.
AIDS Patient Care STDS, 18 (2004), pp. 239-245
[14.]
Y. Falck-Ytter, H. Kale, K.D. Mullen, S.A. Sarbah, L. Sorescu, A.J. McCullough.
Surprisingly small effect of antiviral treatment in patients with hepatitis C.
Ann Intern Med, 136 (2002), pp. 288-292
[15.]
C.A. Fleming, D.E. Craven, D. Thornton, S. Tumilty, D. Nunes.
Hepatitis C virus and human immunodeficiency virus coinfection in an urban population: low eligibility for interferon treatment.
Clin Infect Dis, 36 (2003), pp. 97-100
[16.]
P. Cacoub, P. Halfon, E. Rosenthal, et al.
Treatment of hepatitis C virus in human immunodeficiency virus infected patients in “real life”: modifications in two large surveys between 2004 and 2006.
J Hepatol, 48 (2008), pp. 35-42
[17.]
M. McLaren, G. Garber, C. Cooper.
Barriers to hepatitis treatment in a Canadian HIV-hepatitis C virus coinfection tertiary care clinic.
Can J Gastroenterol, 22 (2008), pp. 133-137
[18.]
A. Restrepo, T.C. Johnson, D. Widjaja, et al.
The rate of treatment of chronic hepatitis C in patients co-infected with HIV in an urban medical centre.
J Viral Hepat, 12 (2005), pp. 86-90
[19.]
M. Sulkowski.
Treatment of hepatitis C in HIV-infected persons: a work in progress.
J Hepatol, 48 (2008), pp. 5-7
[20.]
D. Nunes, R. Saitz, H. Libman, D.M. Cheng, J. Vidaver, J.H. Samet.
Barriers to treatment of hepatitis C in HIV/HCV coinfected adults with alcohol problems.
Alcohol Clin Exp Res, 30 (2006), pp. 1520-1526
[21.]
P. Cacoub, E. Rosenthal, P. Halfon, D. Sene, C. Perronne, S. Pol.
Treatment of hepatitis C virus and human immunodeficiency virus coinfection: from large trials to real life.
J Viral Hepat, 13 (2006), pp. 678-682
[22.]
E.J. Bini, N. Bräu, S. Currie, et al.
Prospective multi-center study of eligibility for antiviral therapy among 4084 U.S. veterans with chronic hepatitis C virus infection.
Am J Gastroenterol, 100 (2005), pp. 1772-1779
[23.]
M. Fireman, D.W. Indest, A. Blackwell, A.J. Whitehead, P. Hauser.
Addressing tri-morbidity (hepatitis C, psychiatric disorders, and substance use): The importance of routine mental health screening as a component of management model of care.
Clin Infect Dis, 40 (2005), pp. S286-S291
[24.]
H.A. Nguyen, A.I. Miller, E. Dieperink, et al.
Spectrum of disease in U.S. veteran patients with hepatitis C.
Am J Gastroenterol, 97 (2002), pp. 1813-1820
[25.]
F. Starace, A. Ammassari, M.P. Trotta, et al.
Depression is a risk factor for suboptimal adherence to highly active antiretroviral therapy.
J Acquir Immune Defic Syndr, 31 (2002), pp. S136-S139
[26.]
J.R. Ickovics, M.E. Hamburger, D. Vlahov, et al.
Mortality CD4 cell count decline, and depressive symptoms among HIV-seropositive women: longitudinal analysis for the HIV Epidemiology Research Study.
JAMA, 285 (2001), pp. 1466-1474
Copyright © 2010. Elsevier Editora Ltda.. All rights reserved