Management of hepatitis C in human immunodeficiency virus-infected patients

"Every drug goes to treat its own disease…" - a qualitative study of perceptions and experiences of taking anti-retrovirals concomitantly with anti-malarials among those affected by HIV and malaria in Tanzania

Background

Little is known about how people living with human immunodeficiency virus (HIV) experience malaria and the concomitant use of anti-malarial treatments with anti-retrovirals (ARVs). An understanding of how patients make sense of these experiences is important to consider in planning and supporting the clinical management and treatment for co-infected individuals.

Methods

A qualitative study was conducted in Tanzania alongside a clinical trial of concomitant treatment for HIV and malaria co-infection. Focus group discussions were held with people receiving treatment for HIV and/or malaria, and in-depth interviews with health workers responsible for HIV care and members of the clinical trial team. Data were analysed inductively to identify themes and develop theoretical narratives.

Results

Results suggest that people living with HIV perceived malaria to be more harmful to them due to their compromised immune status but saw the disease as unavoidable. For those enrolled in the clinical controlled study, taking anti-malarials together with ARVs was largely seen as unproblematic, with health workers’ advice and endorsement of concomitant drug taking influential in reported adherence. However, perceptions of drug strength appeared to compel some people not enrolled in the clinical study to take the drugs at separate times to avoid anticipated harm to the body.

Conclusions

Management of HIV and malaria concurrently often requires individuals to cross the domains of different disease programmes. In the context of a trial concerned with both diseases, patients experienced the support of clinicians in guiding and reassuring them about when and how to take drugs concomitantly. This points towards the need to continue to strive for integrated care for patients with HIV.

The future face of coinfection: prevalence and incidence of HIV and hepatitis C virus coinfection among young injection drug users

The purpose of this study was to determine the prevalence and incidence of HIV and hepatitis C virus (HCV) coinfection among young (aged 29 years or younger) injection drug users (IDUs) and to compare sociodemographic and risk characteristics between (HIV/HCV) coinfected, monoinfected, or HIV- and HCV-negative youth. Data were collected through the Vancouver Injection Drug Users Study (VIDUS). To date, more than 1400 IDUs have been enrolled and followed, of whom 479 were aged 29 years or younger. Semiannually, participants have completed an interviewer-administered questionnaire and have undergone serologic testing for HIV and HCV. Univariate and multivariate logistic regression analyses were undertaken to investigate predictors of baseline coinfection. Cox regression models with time-dependent covariates were used to identify predictors of time to secondary infection seroconversion. A Cochran-Armitage trend test was used to determine risk associations across 3 categories: no infection, monoinfection, and coinfection. Of the 479 young injectors, 78 (16%) were coinfected with HIV and HCV at baseline and a further 45 (15%) with follow-up data became coinfected during the study period. Baseline coinfection was independently associated with being female, being aboriginal, older age, greater number of years injecting, and living in the IDU epicenter. Factors independently associated with time to secondary infection seroconversion were borrowing needles and greater than once-daily cocaine injection, and accessing methadone maintenance therapy in the previous 6 months was protective. There were clear trends across the 3 categories for increasing proportions of female subjects, aboriginal subjects, older age, greater number of years injecting, living in the IDU epicenter, and daily cocaine use. There were a shocking number of youth living with coinfection, particularly female and aboriginal youth. The median number of years injecting for youth seroconverting to a secondary infection was 3 years, suggesting that appropriate public health interventions should be implemented immediately.