1
|
Barbati S, Strasser J, Allemann SS, Arnet I. Initiation of oral hepatitis C virus treatment: Which barriers are pertinent for ambulatory individuals with a history of illicit substance use? A qualitative interview study. Health Sci Rep 2024; 7:e1814. [PMID: 38260184 PMCID: PMC10802086 DOI: 10.1002/hsr2.1814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/01/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
Background and Aims The World Health Organization has set a goal to eradicate hepatitis C virus (HCV) by the year 2030. Nonadherence to HCV treatment has substantial economic implications due to high treatment costs, among others. Barriers to start HCV treatment may be critical. The aim of this study was to assess pertinent barriers to HCV treatment in ambulatory patients with a history of illicit substance use and to compare them to the literature. Methods Barriers to HCV treatment mentioned by the key risk group (i.e., people who inject drugs) were retrieved from literature through a pragmatic literature search. From 34 published articles, we identified 80 modifiable barriers that were bundled in 23 items within the four topics "Personal difficulties and barriers to treatment," "Personal motivation to be treated," "Knowledge about the disease," and "Received information about the medicine." In-depth semistructured interviews were performed face-to-face with ambulatory patients from the University Psychiatric Clinics in Basel, Switzerland. Transcripts were coded inductively. Results Interviews were performed with seven individuals (mean age: 48.3 years; range: 38-63 years; one woman) treated with oral direct-acting antivirals between 2014 and 2022. Thirteen barriers to start HCV treatment were mentioned that corresponded to the five categories: information, attitudes, swallowing difficulties, social environment, and unfavorable lifestyle. The barrier "swallowing difficulties" emerged exclusively from the statements provided by the interviewees. Conclusion Barriers to the initiation of HCV treatment indicated by our interviewees clearly differed from the literature. Notably, the challenge of swallowing medicines may be particularly relevant for physicians prescribing and pharmacists dispensing HCV medication.
Collapse
Affiliation(s)
- Selina Barbati
- Pharmaceutical Care Research Group, Department of Pharmaceutical SciencesUniversity of BaselBaselSwitzerland
| | | | - Samuel S. Allemann
- Pharmaceutical Care Research Group, Department of Pharmaceutical SciencesUniversity of BaselBaselSwitzerland
| | - Isabelle Arnet
- Pharmaceutical Care Research Group, Department of Pharmaceutical SciencesUniversity of BaselBaselSwitzerland
| |
Collapse
|
2
|
Lanièce Delaunay C, Klein MB, Godin A, Cox J, Kronfli N, Lebouché B, Doyle C, Maheu-Giroux M. Public health interventions, priority populations, and the impact of COVID-19 disruptions on hepatitis C elimination among people who have injected drugs in Montreal (Canada): A modeling study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 116:104026. [PMID: 37075626 PMCID: PMC10080278 DOI: 10.1016/j.drugpo.2023.104026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND In Montreal (Canada), high hepatitis C virus (HCV) seroincidence (21 per 100 person-years in 2017) persists among people who have injected drugs (PWID) despite relatively high testing rates and coverage of needle and syringe programs (NSP) and opioid agonist therapy (OAT). We assessed the potential of interventions to achieve HCV elimination (80% incidence reduction and 65% reduction in HCV-related mortality between 2015 and 2030) in the context of COVID-19 disruptions among all PWID and PWID living with HIV. METHODS Using a dynamic model of HCV-HIV co-transmission, we simulated increases in NSP (from 82% to 95%) and OAT (from 33% to 40%) coverage, HCV testing (every 6 months), or treatment rate (100 per 100 person-years) starting in 2022 among all PWID and PWID living with HIV. We also modeled treatment scale-up among active PWID only (i.e., people who report injecting in the past six months). We reduced intervention levels in 2020-2021 due to COVID-19-related disruptions. Outcomes included HCV incidence, prevalence, and mortality, and proportions of averted chronic HCV infections and deaths. RESULTS COVID-19-related disruptions could have caused temporary rebounds in HCV transmission. Further increasing NSP/OAT or HCV testing had little impact on incidence. Scaling-up treatment among all PWID achieved incidence and mortality targets among all PWID and PWID living with HIV. Focusing treatment on active PWID could achieve elimination, yet fewer projected deaths were averted (36% versus 48%). CONCLUSIONS HCV treatment scale-up among all PWID will be required to eliminate HCV in high-incidence and prevalence settings. Achieving elimination by 2030 will entail concerted efforts to restore and enhance pre-pandemic levels of HCV prevention and care.
Collapse
Affiliation(s)
- Charlotte Lanièce Delaunay
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Marina B Klein
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada; CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - Arnaud Godin
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Joseph Cox
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nadine Kronfli
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Bertrand Lebouché
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada; Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Carla Doyle
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - Mathieu Maheu-Giroux
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.
| |
Collapse
|
3
|
Di Ciaccio M, Villes V, Perfect C, El Kaim JL, Donatelli M, James C, Easterbrook P, Delabre RM. Need for integration of hepatitis C (HCV) services in community-based settings for people who inject drugs: results from a global values and preferences survey. Harm Reduct J 2023; 20:15. [PMID: 36759855 PMCID: PMC9909907 DOI: 10.1186/s12954-023-00743-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/25/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND To inform the development of updated World Health Organization (WHO) guidelines on simplified service delivery for HCV infection, a global survey was undertaken among people affected or infected by HCV. The objective of this analysis is to identify specific needs and preferences among people who inject drugs. METHODS A multi-country, anonymous, self-administered online survey conducted in 2021 was developed by Coalition PLUS and the World Hepatitis Alliance in partnership with the WHO. Preferences for test and treat locations and simplifying HCV care were collected among people affected or infected by HCV. Chi-square tests were used to compare respondents who identified with current or former injection drug users through identification with key population to other respondents who did not identify with this key population. RESULTS Among 202 respondents, 62 (30.7%) identified with current/former injection drug users. Compared to other respondents, they were: older [median (IQR): 48 (36-57) vs. 39 (31-51) years, p = 0.003]; more likely to have been tested for HCV (90.2% vs. 64.3%, p = 0.001); more likely to prefer testing in a community-based centre (CBC) (55.4% vs. 33.3%, p = 0.005); or in a support centres for people who use drugs (SCPUD)(50.0% vs. 9.8%, p < 0.001). The most important considerations regarding testing locations among people identified with current/former injection drug users (compared to the other respondents) were: non-judgemental atmosphere (p < 0.001), anonymity (p = 0.018) and community worker (CW) presence (p < 0.001). People identified with current/former injection drug users were more likely to prefer to receive HCV treatment in a CBC (63.0% vs. 44.8%, p = 0.028) or in a SCPUD (46.3% vs. 9.5%, p < 0.001), compared to the other respondents. The most important considerations regarding treatment locations among people identified with current/former injection drug users were the non-stigmatising/non-judgemental approach at the site (p < 0.001) and the presence of community-friendly medical personnel or CW (p = 0.016 and 0.002), compared to the other respondents. CONCLUSION The preferences of people identified with current/former injection drug users indicated specific needs concerning HCV services. Integration of HCV services in community-based risk reduction centres may be an important element in the development of adapted services to increase uptake and retention in HCV care among this population.
Collapse
Affiliation(s)
- M. Di Ciaccio
- Community-Based Research Laboratory, Coalition PLUS, Pantin, France
| | - V. Villes
- Community-Based Research Laboratory, Coalition PLUS, Pantin, France
| | - C. Perfect
- Advocacy Department, Coalition PLUS, Pantin, France
| | | | - M. Donatelli
- Advocacy Department, Coalition PLUS, Pantin, France
| | - C. James
- World Hepatitis Alliance, London, UK
| | - P. Easterbrook
- grid.3575.40000000121633745Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - R. M. Delabre
- Community-Based Research Laboratory, Coalition PLUS, Pantin, France
| |
Collapse
|
4
|
Mendlowitz AB, Feld JJ, Biondi MJ. Hepatitis B and C in Pregnancy and Children: A Canadian Perspective. Viruses 2022; 15:91. [PMID: 36680130 PMCID: PMC9863739 DOI: 10.3390/v15010091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/24/2022] [Accepted: 12/27/2022] [Indexed: 12/30/2022] Open
Abstract
In 2016, the World Health Organization released a plan to eliminate viral hepatitis as a public health threat by 2030. For Canada to achieve the recommended decreases in HBV- and HCV-related new diagnoses and deaths, an increase in services is urgently required. Identifying those at risk of, or who have acquired HBV and HCV, remains a challenge, especially with the emergence of new priority populations such as pregnant persons and children. Importantly, prenatal, and pediatric care are times when individuals are often already engaged with the healthcare system, leading to the potential for opportunistic or co-localized care and interventions. At present, Canada may not be maximizing all available virologic tools that could lead to increases in prevention, identification, improved management, or even cure. Here, we describe the continuum of care that includes preconception, prenatal, postpartum, and pediatric stages; and identify current global and Canadian recommendations, findings, and opportunities for improvement.
Collapse
Affiliation(s)
- Andrew B. Mendlowitz
- Viral Hepatitis Care Network, Toronto Centre for Liver Disease, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Jordan J. Feld
- Viral Hepatitis Care Network, Toronto Centre for Liver Disease, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Mia J. Biondi
- Viral Hepatitis Care Network, Toronto Centre for Liver Disease, University Health Network, Toronto, ON M5G 2C4, Canada
- School of Nursing, York University, Toronto, ON M3J 1P3, Canada
| |
Collapse
|
5
|
Marathe G, Moodie EEM, Brouillette MJ, Cox J, Delaunay CL, Cooper C, Hull M, Gill J, Walmsley S, Pick N, Klein MB. Depressive symptoms are no longer a barrier to HCV treatment initiation in the HIV–HCV co-infected population in Canada. Antivir Ther 2022. [DOI: 10.1177/13596535211067610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Psychiatric illness was a major barrier for HCV treatment during the Interferon (IFN) treatment era due to neuropsychiatric side effects. While direct acting antivirals (DAA) are better tolerated, patient-level barriers persist. We aimed to assess the effect of depressive symptoms on time to HCV treatment initiation among HIV–HCV co-infected persons during the IFN (2003–2011) and second-generation DAA (2013–2020) eras. Methods We used data from the Canadian Co-infection Cohort, a multicentre prospective cohort, and its associated sub-study on Food Security (FS). We predicted Center for Epidemiologic Studies Depression Scale-10 (CES-D-10) classes for depressive symptoms indicative of a depression risk using a random forest classifier and corrected for misclassification using predictive value-based record-level correction. We used marginal structural Cox proportional hazards models with inverse weighting for competing risks (death) to assess the effect of depressive symptoms on treatment initiation among HCV RNA-positive participants. Results We included 590 and 1127 participants in the IFN and DAA eras. The treatment initiation rate increased from 9 (95% confidence interval (CI): 7–10) to 21 (95% CI: 19–22) per 100 person-years from the IFN to DAA era. Treatment initiation was lower among those with depressive symptoms compared to those without in the IFN era (hazard ratio: 0.81 (95% CI: 0.69–0.95)) and was higher in the DAA era (1.19 (95% CI: 1.10–1.27)). Conclusion Depressive symptoms no longer appear to be a barrier to HCV treatment initiation in the co-infected population in the DAA era. The higher rate of treatment initiation in individuals with depressive symptoms suggests those previously unable to tolerate IFN are now accessing treatment.
Collapse
Affiliation(s)
- Gayatri Marathe
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, McGill University Health Center-Research Institute, Montreal, Quebec, Canada
| | - Erica E M Moodie
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Marie-Josée Brouillette
- Centre for Outcomes Research and Evaluation, McGill University Health Center-Research Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Joseph Cox
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, McGill University Health Center-Research Institute, Montreal, Quebec, Canada
| | - Charlotte Lanièce Delaunay
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, McGill University Health Center-Research Institute, Montreal, Quebec, Canada
| | - Curtis Cooper
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mark Hull
- St. Paul’s Hospital, Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - John Gill
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sharon Walmsley
- Department of Medicine, University of Toronto, Ontario, Canada
| | - Neora Pick
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, British Columbia, Canada
| | - Marina B Klein
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, McGill University Health Center-Research Institute, Montreal, Quebec, Canada
- CIHR Canadian HIV Trials Network (CTN), Vancouver, British Columbia, Canada
| | | |
Collapse
|
6
|
Ortiz-Paredes D, Amoako A, Lessard D, Engler K, Lebouché B, Klein MB. Potential interventions to support HCV treatment uptake among HIV co-infected people in Canada: Perceptions of patients and health care providers. CANADIAN LIVER JOURNAL 2022; 5:14-30. [DOI: 10.3138/canlivj-2021-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 08/28/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND: Increasing direct-acting antiviral (DAA) treatment uptake is key to eliminating HCV infection as a public health threat in Canada. People living with human immunodeficiency virus (HIV) and hepatitis C (HCV) co-infection face barriers to HCV treatment initiation. We sought to identify interventions that could support HCV treatment initiation based on patient and HCV care provider perspectives. METHODS: Eleven people living with HIV with a history of HCV infection and 12 HCV care providers were recruited for this qualitative descriptive study. Participants created ranked-ordered lists of potential interventions during nominal groups ( n = 4) and individual interviews ( n = 6). Following the nominal group technique, transcripts and intervention lists underwent thematic analysis and ranking scores were merged to create consolidated and prioritized lists from patient and provider perspectives. RESULTS: Patient participants identified a total of eight interventions. The highest-ranked interventions were multidisciplinary clinics, HCV awareness campaigns and patient education, nurse- or pharmacist-led care, peer involvement, and more and better-prepared health professionals. Provider participants identified 11 interventions. The highest-ranked were mobile outreach, DAA initiation at pharmacies, a simplified process of DAA prescription, integration of primary and specialist care, and patient-centred approaches. CONCLUSION: Participants proposed alternatives to hospital-based specialist HCV care, which require increasing capacity for nurses, pharmacists, primary care providers, and peers to have more direct roles in HCV treatment provision. They also identified the need for structural changes and educational initiatives. In addition to optimizing HCV care, these interventions might result in broader benefits for the health of HIV–HCV co-infected people.
Collapse
Affiliation(s)
- David Ortiz-Paredes
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Afia Amoako
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - David Lessard
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Kim Engler
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Bertrand Lebouché
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- Department of Medicine, Division of Infectious Diseases/Chronic Viral Illness Service, Glen site, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marina B Klein
- Department of Medicine, Division of Infectious Diseases/Chronic Viral Illness Service, Glen site, McGill University Health Centre, Montreal, Quebec, Canada
| |
Collapse
|
7
|
Ortiz-Paredes D, Amoako A, Lessard D, Engler K, Lebouché B, Klein MB. Barriers and facilitators related to HCV treatment uptake among HIV coinfected populations in Canada: Patients and treatment provider perceptions. CANADIAN LIVER JOURNAL 2021; 5:124-143. [DOI: 10.3138/canlivj-2021-0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/03/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND: Direct-acting antiviral (DAA) uptake is challenging across HIV-hepatitis C (HCV) coinfected populations. This study sought to identify barriers and facilitators related to DAA uptake in priority populations in Canada. METHODS: This qualitative descriptive study included 11 people living with HIV with a history of HCV and 15 HCV care providers. Participants were part of either nominal groups (n = 4) or individual interviews (n = 6) in which they identified and ranked barriers and facilitators to DAA uptake. Consolidated lists of barriers and facilitators were identified thematically. RESULTS: Patient participants highly ranked the following barriers: competing priorities and needs (i.e., social instability and mental health), delays in care, lack of adherence, and polypharmacy. Provider participant top barriers were the following: competing priorities and needs (i.e., social chaos), delays in care (e.g., systemic barriers, difficulties engaging patients, lack of trained HCV providers), and HCV-related stigma. Patient participants identified having a strong network of health care providers, family, and friends, possessing intrinsic motivation, and DAAs being a simple and tolerable oral treatment as important facilitators. Provider participant top-ranked facilitators were having resources to identify hard-to-reach populations (e.g., patient navigation, outreach), holistic care and addiction management, provider HCV education, and a strong network of interprofessional collaboration. CONCLUSION: The barriers to DAA initiation addressed by patients and providers overlapped, with some nuances. Multidisciplinary care fostering a strong supportive network and intrinsically motivated patients along with HCV education emerged as key facilitators. This study provides insights for developing potential strategies to improve DAA uptake among HIV-HCV coinfected people in Canada.
Collapse
Affiliation(s)
- David Ortiz-Paredes
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Afia Amoako
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - David Lessard
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Kim Engler
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Bertrand Lebouché
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- Department of Medicine, Division of Infectious Diseases/Chronic Viral Illness Service, Glen site, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marina B. Klein
- Department of Medicine, Division of Infectious Diseases/Chronic Viral Illness Service, Glen site, McGill University Health Centre, Montreal, Quebec, Canada
| |
Collapse
|
8
|
Autologous bone marrow cell transplantation in the treatment of HIV patients with compensated cirrhosis. Biosci Rep 2021; 40:225234. [PMID: 32520354 PMCID: PMC7313450 DOI: 10.1042/bsr20191316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 05/19/2020] [Accepted: 06/03/2020] [Indexed: 12/20/2022] Open
Abstract
Liver stem cell therapy is a promising tool to improve decompensated liver cirrhosis (DLC). Especially in patients infected with human immunodeficiency virus (HIV), the condition of the liver may be aggravated by antiretroviral therapy. A total of 21 patients diagnosed with DLC and HIV infection were divided into two groups as follows: those who received (combination therapy group, 14 patients) and those who did not receive (routine therapy group, 7 patients) bone marrow cell transplantation through the portal vein. Two patients died of surgery-related complications in the combination therapy group. The results showed that the survival rate was 85.7% in the combination therapy group after 2 years of follow-up, which was significantly higher than the 14.3% in the conventional therapy group (P<0.01). After treatment, the liver function score decreased significantly in the combination therapy group at 1 (t = 4.276, P = 0.000), 3 (t = 9.153, P = 0.000), and 12 (t = 13.536, P = 0.000) months, the levels of albumin were significantly increased, and the total bilirubin level and prothrombin time were significantly reduced or shortened as compared with the routine therapy group (P<0.05 or <0.01). The white blood cell count, hemoglobin, platelet count, and CD4+ and CD8+ levels were significantly higher in the combination therapy group at different time points as compared with the routine therapy group (P<0.05 or <0.01). In summary, the combination therapy is effective in HIV-infected patients with DLC and useful for the recovery of liver function and cellular immune function but may increase the risk of severe complications after surgery.
Collapse
|
9
|
Cooper C, Driedger M, Wong D, Haylock-Jacobs S, Aziz Shaheen A, Osiowy C, Fung S, Doucette K, Wong A, Barrett L, Conway B, Ramji A, Minuk G, Sebastiani G, Wong P, Coffin CS. Distinct Hepatitis B and HIV co-infected populations in Canada. J Viral Hepat 2021; 28:517-527. [PMID: 33306853 DOI: 10.1111/jvh.13453] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/02/2020] [Accepted: 11/18/2020] [Indexed: 12/15/2022]
Abstract
Due to shared modes of exposure, HIV-HBV co-infection is common worldwide. Increased knowledge of the demographic and clinical characteristics of the co-infected population will allow us to optimize our approach to management of both infections in clinical practice. The Canadian Hepatitis B Network Cohort was utilized to conduct a cross-sectional evaluation of the demographic, biochemical, fibrotic and treatment characteristics of HIV-HBV patients and a comparator HBV group. From a total of 5996 HBV-infected patients, 335 HIV-HBV patients were identified. HIV-HBV patients were characterized by older median age, higher male and lower Asian proportion, more advanced fibrosis and higher anti-HBV therapy use (91% vs. 30%) than the HBV-positive / HIV seronegative comparator group. A history of reported high-risk exposure activities (drug use, high-risk sexual contact) was more common in HIV-HBV patients. HIV-HBV patients with reported high-risk exposure activities had higher male proportion, more Caucasian ethnicity and higher prevalence of cirrhosis than HIV-HBV patients born in an endemic country. In the main cohort, age ≥60 years, male sex, elevated ALT, the presence of comorbidity and HCV seropositivity were independent predictors of significant fibrosis. HIV seropositivity was not an independent predictor of advanced fibrosis (adj OR 0.75 [95%CI: 0.34-1.67]). In conclusion, Canadian co-infected patients differed considerably from those with mono-infection. Furthermore, HIV-HBV-infected patients who report high-risk behaviours and those born in endemic countries represent two distinct subpopulations, which should be considered when engaging these patients in care.
Collapse
Affiliation(s)
| | | | - David Wong
- University of Toronto, Toronto, Ontario, Canada
| | | | | | - Carla Osiowy
- National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | - Scott Fung
- University of Toronto, Toronto, Ontario, Canada
| | | | - Alexander Wong
- University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Lisa Barrett
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Brian Conway
- Vancouver Infectious Disease Centre, Vancouver, British Columbia, Canada
| | - Alnoor Ramji
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Gerald Minuk
- University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | | |
Collapse
|
10
|
Saeed S, Strumpf E, Moodie EEM, Wong L, Cox J, Walmsley S, Tyndall M, Cooper C, Conway B, Hull M, Martel-Laferriere V, Gill J, Wong A, Vachon ML, Klein MB. Eliminating Structural Barriers: The Impact of Unrestricted Access on Hepatitis C Treatment Uptake Among People Living With Human Immunodeficiency Virus. Clin Infect Dis 2020; 71:363-371. [PMID: 31504327 PMCID: PMC7353326 DOI: 10.1093/cid/ciz833] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/27/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND High costs of direct-acting antivirals (DAAs) have led health-care insurers to limit access worldwide. Using a natural experiment, we evaluated the impact of removing fibrosis stage restrictions on hepatitis C (HCV) treatment initiation rates among people living with human immunodeficiency virus (HIV), and then examined who was left to be treated. METHODS Using data from the Canadian HIV-HCV Coinfection Cohort, we applied a difference-in-differences approach. Changes in treatment initiation rates following the removal of fibrosis stage restrictions were assessed using a negative binomial regression with generalized estimating equations. The policy change was then specifically assessed among people who inject drugs (PWID). We then identified the characteristics of participants who remained to be treated using a modified Poisson regression. RESULTS Between 2010-2018, there were a total of 585 HCV initiations among 1130 eligible participants. After removing fibrosis stage restrictions, DAA initiations increased by 1.8-fold (95% confidence interval [CI] 1.3-2.4) controlling for time-invariant differences and secular trends. Among PWID the impact appeared even stronger, with an adjusted incidence rate ratio of 3.6 (95% CI 1.8-7.4). However, this increased treatment uptake was not sustained. At 1 year following universal access, treatment rates declined to 0.8 (95% CI .5-1.1). Marginalized participants (PWID and those of indigenous ethnicity) and those disengaged from care were more likely to remain HCV RNA positive. CONCLUSIONS After the removal of fibrosis restrictions, HCV treatment initiations nearly doubled immediately, but this treatment rate was not sustained. To meet the World Health Organization elimination targets, the minimization of structural barriers and adoption of tailored interventions are needed to engage and treat all vulnerable populations.
Collapse
Affiliation(s)
- Sahar Saeed
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Erin Strumpf
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
- Department of Economics, McGill University, Montreal, Canada
| | - Erica E M Moodie
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Leo Wong
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Joseph Cox
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Sharon Walmsley
- University Health Network, University of Toronto, Toronto, Canada
- Canadian Institute for Health Research, Canadian Human Immunodeficiency Virus Trials Network,, Vancouver, Canada
| | - Mark Tyndall
- British Columbia Centre for Disease Control, University of British Columbia, Vancouver, Canada
| | - Curtis Cooper
- Canadian Institute for Health Research, Canadian Human Immunodeficiency Virus Trials Network,, Vancouver, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Brian Conway
- Vancouver Infectious Diseases Centre, Vancouver, Canada
| | - Mark Hull
- Canadian Institute for Health Research, Canadian Human Immunodeficiency Virus Trials Network,, Vancouver, Canada
- British Columbia Centre of Excellence, St. Paul’s Hospital, Vancouver, Canada
| | - Valerie Martel-Laferriere
- Departement de Microbiologie et Infectiologie, Centre Hospitalier de l’Université de Montréal, Montreal, Canada
| | - John Gill
- Southern Alberta Human Immunodeficiency Virus Clinic, Calgary, Canada
| | | | | | - Marina B Klein
- Research Institute of the McGill University Health Centre, Montreal, Canada
- Canadian Institute for Health Research, Canadian Human Immunodeficiency Virus Trials Network,, Vancouver, Canada
| |
Collapse
|
11
|
Sacks-Davis R, Doyle JS, Rauch A, Beguelin C, Pedrana AE, Matthews GV, Prins M, van der Valk M, Klein MB, Saeed S, Lacombe K, Chkhartishvili N, Altice FL, Hellard ME. Linkage and retention in HCV care for HIV-infected populations: early data from the DAA era. J Int AIDS Soc 2019; 21 Suppl 2:e25051. [PMID: 29633559 PMCID: PMC5978682 DOI: 10.1002/jia2.25051] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 12/19/2017] [Indexed: 12/17/2022] Open
Abstract
Introduction There is currently no published data on the effectiveness of DAA treatment for elimination of HCV infection in HIV‐infected populations at a population level. However, a number of relevant studies and initiatives are emerging. This research aims to report cascade of care data for emerging HCV elimination initiatives and studies that are currently being evaluated in HIV/HCV co‐infected populations in the context of implementation science theory. Methods HCV elimination initiatives and studies in HIV co‐infected populations that are currently underway were identified. Context, intervention characteristics and cascade of care data were synthesized in the context of implementation science frameworks. Results Seven HCV elimination initiatives and studies were identified in HIV co‐infected populations, mainly operating in high‐income countries. Four were focused mainly on HCV elimination in HIV‐infected gay and bisexual men (GBM), and three included a combination of people who inject drugs (PWID), GBM and other HIV‐infected populations. None were evaluating treatment delivery in incarcerated populations. Overall, HCV RNA was detected in 4894 HIV‐infected participants (range within studies: 297 to 994): 48% of these initiated HCV treatment (range: 21% to 85%; within studies from a period where DAAs were broadly available the total is 57%, range: 36% to 74%). Among studies with treatment completion data, 96% of 1109 initiating treatment completed treatment (range: 94% to 99%). Among those who could be assessed for sustained virological response at 12 weeks (SVR12), 1631 of 1757 attained SVR12 (93%, range: 86% to 98%). Conclusions Early results from emerging research on HCV elimination in HIV‐infected populations suggest that HCV treatment uptake is higher than reported levels prior to DAA treatment availability, but approximately half of patients remain untreated. These results are among diagnosed populations and additional effort is required to increase diagnosis rates. Among those who have initiated treatment, completion and SVR rates are promising. More data are required in order to evaluate the effectiveness of these elimination programmes in the long term, assess which intervention components are effective, and whether they need to be tailored to particular population groups.
Collapse
Affiliation(s)
- Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Andri Rauch
- Department of Infectious Diseases, University Hospital and University of Bern, Bern, Switzerland
| | - Charles Beguelin
- Department of Infectious Diseases, University Hospital and University of Bern, Bern, Switzerland
| | - Alisa E Pedrana
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Gail V Matthews
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Maria Prins
- Public Health Service Amsterdam, Amsterdam, the Netherlands
| | - Marc van der Valk
- International Antiviral Therapy Evaluation Center and Department of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, Amsterdam, the Netherlands
| | - Marina B Klein
- Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
| | - Sahar Saeed
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Karine Lacombe
- Infectious Diseases, AP-HP, Sorbonne Universités and Inserm UMR-S1136, Paris, France
| | | | - Frederick L Altice
- Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA.,Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.,Centre of Excellence in Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia
| | - Margaret E Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
12
|
Shah H, Bilodeau M, Burak KW, Cooper C, Klein M, Ramji A, Smyth D, Feld JJ. The management of chronic hepatitis C: 2018 guideline update from the Canadian Association for the Study of the Liver. CMAJ 2019; 190:E677-E687. [PMID: 29866893 DOI: 10.1503/cmaj.170453] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Hemant Shah
- Toronto Centre for Liver Disease (Shah, Feld), Toronto Western and General Hospital, University Health Network, University of Toronto, Toronto, Ont.; Department of Medicine, Liver Unit (Bilodeau), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Department of Medicine, Liver Unit, Division of Gastroenterology and Hepatology (Burak), University of Calgary, Calgary, Alta.; Division of Infectious diseases (Cooper), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases and Chronic Viral Illness Service Glen site (Klein), McGill University Health Centre Montréal, Que.; Department of Medicine, Division of Gastroenterology (Ramji), University of British Columbia, Vancouver, BC; Division of Infectious Disease (Smyth), Dalhousie University, Moncton Hospital, Moncton, NB
| | - Marc Bilodeau
- Toronto Centre for Liver Disease (Shah, Feld), Toronto Western and General Hospital, University Health Network, University of Toronto, Toronto, Ont.; Department of Medicine, Liver Unit (Bilodeau), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Department of Medicine, Liver Unit, Division of Gastroenterology and Hepatology (Burak), University of Calgary, Calgary, Alta.; Division of Infectious diseases (Cooper), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases and Chronic Viral Illness Service Glen site (Klein), McGill University Health Centre Montréal, Que.; Department of Medicine, Division of Gastroenterology (Ramji), University of British Columbia, Vancouver, BC; Division of Infectious Disease (Smyth), Dalhousie University, Moncton Hospital, Moncton, NB
| | - Kelly W Burak
- Toronto Centre for Liver Disease (Shah, Feld), Toronto Western and General Hospital, University Health Network, University of Toronto, Toronto, Ont.; Department of Medicine, Liver Unit (Bilodeau), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Department of Medicine, Liver Unit, Division of Gastroenterology and Hepatology (Burak), University of Calgary, Calgary, Alta.; Division of Infectious diseases (Cooper), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases and Chronic Viral Illness Service Glen site (Klein), McGill University Health Centre Montréal, Que.; Department of Medicine, Division of Gastroenterology (Ramji), University of British Columbia, Vancouver, BC; Division of Infectious Disease (Smyth), Dalhousie University, Moncton Hospital, Moncton, NB
| | - Curtis Cooper
- Toronto Centre for Liver Disease (Shah, Feld), Toronto Western and General Hospital, University Health Network, University of Toronto, Toronto, Ont.; Department of Medicine, Liver Unit (Bilodeau), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Department of Medicine, Liver Unit, Division of Gastroenterology and Hepatology (Burak), University of Calgary, Calgary, Alta.; Division of Infectious diseases (Cooper), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases and Chronic Viral Illness Service Glen site (Klein), McGill University Health Centre Montréal, Que.; Department of Medicine, Division of Gastroenterology (Ramji), University of British Columbia, Vancouver, BC; Division of Infectious Disease (Smyth), Dalhousie University, Moncton Hospital, Moncton, NB
| | - Marina Klein
- Toronto Centre for Liver Disease (Shah, Feld), Toronto Western and General Hospital, University Health Network, University of Toronto, Toronto, Ont.; Department of Medicine, Liver Unit (Bilodeau), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Department of Medicine, Liver Unit, Division of Gastroenterology and Hepatology (Burak), University of Calgary, Calgary, Alta.; Division of Infectious diseases (Cooper), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases and Chronic Viral Illness Service Glen site (Klein), McGill University Health Centre Montréal, Que.; Department of Medicine, Division of Gastroenterology (Ramji), University of British Columbia, Vancouver, BC; Division of Infectious Disease (Smyth), Dalhousie University, Moncton Hospital, Moncton, NB
| | - Alnoor Ramji
- Toronto Centre for Liver Disease (Shah, Feld), Toronto Western and General Hospital, University Health Network, University of Toronto, Toronto, Ont.; Department of Medicine, Liver Unit (Bilodeau), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Department of Medicine, Liver Unit, Division of Gastroenterology and Hepatology (Burak), University of Calgary, Calgary, Alta.; Division of Infectious diseases (Cooper), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases and Chronic Viral Illness Service Glen site (Klein), McGill University Health Centre Montréal, Que.; Department of Medicine, Division of Gastroenterology (Ramji), University of British Columbia, Vancouver, BC; Division of Infectious Disease (Smyth), Dalhousie University, Moncton Hospital, Moncton, NB
| | - Dan Smyth
- Toronto Centre for Liver Disease (Shah, Feld), Toronto Western and General Hospital, University Health Network, University of Toronto, Toronto, Ont.; Department of Medicine, Liver Unit (Bilodeau), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Department of Medicine, Liver Unit, Division of Gastroenterology and Hepatology (Burak), University of Calgary, Calgary, Alta.; Division of Infectious diseases (Cooper), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases and Chronic Viral Illness Service Glen site (Klein), McGill University Health Centre Montréal, Que.; Department of Medicine, Division of Gastroenterology (Ramji), University of British Columbia, Vancouver, BC; Division of Infectious Disease (Smyth), Dalhousie University, Moncton Hospital, Moncton, NB
| | - Jordan J Feld
- Toronto Centre for Liver Disease (Shah, Feld), Toronto Western and General Hospital, University Health Network, University of Toronto, Toronto, Ont.; Department of Medicine, Liver Unit (Bilodeau), Centre hospitalier de l'Université de Montréal, Montréal, Que.; Department of Medicine, Liver Unit, Division of Gastroenterology and Hepatology (Burak), University of Calgary, Calgary, Alta.; Division of Infectious diseases (Cooper), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; Division of Infectious Diseases and Chronic Viral Illness Service Glen site (Klein), McGill University Health Centre Montréal, Que.; Department of Medicine, Division of Gastroenterology (Ramji), University of British Columbia, Vancouver, BC; Division of Infectious Disease (Smyth), Dalhousie University, Moncton Hospital, Moncton, NB
| | | |
Collapse
|
13
|
Cooper CL. Now Is the Time to Quickly Eliminate Barriers Along the Hepatitis C Cascade of Care. J Infect Dis 2019. [PMID: 29534217 DOI: 10.1093/infdis/jiy117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
|
14
|
HIV Serostatus and Having Access to a Physician for Regular Hepatitis C Virus Care Among People Who Inject Drugs. J Acquir Immune Defic Syndr 2019; 78:93-98. [PMID: 29630030 DOI: 10.1097/qai.0000000000001651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND People who inject drugs (PWIDs) and who are living with HIV and hepatitis C virus (HCV) infection are vulnerable to a range of health-related harms, including liver cirrhosis, hepatocellular carcinoma, and death. There is limited evidence describing how HIV serostatus shapes access to a physician for regular HCV care among PWID. SETTING Data were collected through the Vancouver Injection Drug Users Study (VIDUS), the AIDS Care Cohort to evaluate Exposure to Survival Services (ACCESS), and the At-Risk Youth Study (ARYS), 3 prospective cohorts involving people who use illicit drugs in Vancouver, Canada, between 2005 and 2015. METHODS Using generalized estimating equations, we examined the relationship between HIV-seropositivity and having access to a physician for regular HCV care. We conducted a mediation analysis to examine whether this association was mediated by increased frequency of engagement in health care. RESULTS In total, 1627 HCV-positive PWID were eligible for analysis; 582 (35.8%) were HIV-positive at baseline; and 31 (1.9%) became HIV-positive during follow-up. In multivariable analyses, after adjusting for a range of confounders, HIV serostatus [adjusted odds ratio = 1.99; 95% confidence interval: 1.77 to 2.24] was significantly associated with having access to HCV care. Approximately 26% of the effect was due to mediation. CONCLUSION Our results demonstrate a positive relationship between HIV-seropositivity and having access to a physician for regular HCV care, which is partially explained through increased frequency of engagement in health care. These findings highlight the need to address patterns of inequality in access to HCV care among PWID.
Collapse
|
15
|
Methadone treatment, severe food insecurity, and HIV-HCV co-infection: A propensity score matching analysis. Drug Alcohol Depend 2018; 185:374-380. [PMID: 29544189 DOI: 10.1016/j.drugalcdep.2017.12.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/22/2017] [Accepted: 12/28/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Severe food insecurity (FI) is common among individuals living with HIV-hepatitis C virus (HCV) co-infection. We hypothesize that the injection of opioids is partly responsible for the association between injection drug use and severe FI. Therefore, this analysis examines whether methadone maintenance treatment for opioid dependence is associated with a lower risk of severe FI. METHODS We used biannual data from the Canadian Co-infection Cohort (N = 608, 2012-2015). Methadone treatment (exposure) was self-reported and severe FI (outcome) was measured using the Household Food Security Survey Module. To quantify the association between methadone treatment and severe FI, we estimated an average treatment effect on the treated (marginal risk difference [RD]) using propensity score matching. RESULTS Among participants, 25% experienced severe FI in the six months preceding the first time-point in the analytical sample and 5% concurrently reported receiving methadone treatment. Injection of opioids in the six months preceding the treatment and outcome measurements was much higher among those who received methadone treatment (39% vs. 12%). Among the treated participants, 97% had injected opioids in their lifetimes. After propensity score matching, the average risk of experiencing severe FI is 12.3 percentage-points lower among those receiving methadone treatment, compared to those who are not receiving treatment (marginal RD = -0.123, 95% CI = -0.230, -0.015). CONCLUSIONS After adjustment for socioeconomic, sociodemographic, behavioural, and clinical confounders, methadone treatment is associated with a lower risk of severe FI. This finding suggests that methadone treatment may mitigate severe FI in this vulnerable subset of the HIV-positive population.
Collapse
|
16
|
Patel K, Maguire E, Chartier M, Akpan I, Rogal S. Integrating Care for Patients With Chronic Liver Disease and Mental Health and Substance Use Disorders. Fed Pract 2018; 35:S14-S23. [PMID: 30766391 PMCID: PMC6375404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Mental health disorders are common among patients with chronic liver disease, and current literature supports the use of better screening and providing integrated or multidisciplinary care where possible.
Collapse
Affiliation(s)
- Krupa Patel
- is an Assistant Professor and is a Resident at University of Pittsburgh in Pennsylvania. is a Gastroenterologist at Baylor Scott & White Health, Texas. is a Health Communications Researcher at the Center for Healthcare Organization and Implementation Research at Bedford VAMC in Massachusetts. is the Deputy Director and the National Infectious Diseases Officer and Ms. Maguire is Communications Lead at the Veterans Health Administration, Office of Specialty Care Services, HIV, Hepatitis, and Related Conditions Programs. Dr. Rogal is a Gastroenterologist, Transplant Hepatologist, and an Investigator at the Center for Health Equity Research and Promotion at VA Pittsburgh Healthcare System
| | - Elizabeth Maguire
- is an Assistant Professor and is a Resident at University of Pittsburgh in Pennsylvania. is a Gastroenterologist at Baylor Scott & White Health, Texas. is a Health Communications Researcher at the Center for Healthcare Organization and Implementation Research at Bedford VAMC in Massachusetts. is the Deputy Director and the National Infectious Diseases Officer and Ms. Maguire is Communications Lead at the Veterans Health Administration, Office of Specialty Care Services, HIV, Hepatitis, and Related Conditions Programs. Dr. Rogal is a Gastroenterologist, Transplant Hepatologist, and an Investigator at the Center for Health Equity Research and Promotion at VA Pittsburgh Healthcare System
| | - Maggie Chartier
- is an Assistant Professor and is a Resident at University of Pittsburgh in Pennsylvania. is a Gastroenterologist at Baylor Scott & White Health, Texas. is a Health Communications Researcher at the Center for Healthcare Organization and Implementation Research at Bedford VAMC in Massachusetts. is the Deputy Director and the National Infectious Diseases Officer and Ms. Maguire is Communications Lead at the Veterans Health Administration, Office of Specialty Care Services, HIV, Hepatitis, and Related Conditions Programs. Dr. Rogal is a Gastroenterologist, Transplant Hepatologist, and an Investigator at the Center for Health Equity Research and Promotion at VA Pittsburgh Healthcare System
| | - Imo Akpan
- is an Assistant Professor and is a Resident at University of Pittsburgh in Pennsylvania. is a Gastroenterologist at Baylor Scott & White Health, Texas. is a Health Communications Researcher at the Center for Healthcare Organization and Implementation Research at Bedford VAMC in Massachusetts. is the Deputy Director and the National Infectious Diseases Officer and Ms. Maguire is Communications Lead at the Veterans Health Administration, Office of Specialty Care Services, HIV, Hepatitis, and Related Conditions Programs. Dr. Rogal is a Gastroenterologist, Transplant Hepatologist, and an Investigator at the Center for Health Equity Research and Promotion at VA Pittsburgh Healthcare System
| | - Shari Rogal
- is an Assistant Professor and is a Resident at University of Pittsburgh in Pennsylvania. is a Gastroenterologist at Baylor Scott & White Health, Texas. is a Health Communications Researcher at the Center for Healthcare Organization and Implementation Research at Bedford VAMC in Massachusetts. is the Deputy Director and the National Infectious Diseases Officer and Ms. Maguire is Communications Lead at the Veterans Health Administration, Office of Specialty Care Services, HIV, Hepatitis, and Related Conditions Programs. Dr. Rogal is a Gastroenterologist, Transplant Hepatologist, and an Investigator at the Center for Health Equity Research and Promotion at VA Pittsburgh Healthcare System
| |
Collapse
|
17
|
Saeed S, Strumpf EC, Moodie EE, Young J, Nitulescu R, Cox J, Wong A, Walmsely S, Cooper C, Vachon ML, Martel-Laferriere V, Hull M, Conway B, Klein MB. Disparities in direct acting antivirals uptake in HIV-hepatitis C co-infected populations in Canada. J Int AIDS Soc 2018; 20. [PMID: 29116684 PMCID: PMC5810331 DOI: 10.1002/jia2.25013] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 09/25/2017] [Indexed: 12/27/2022] Open
Abstract
Background Direct acting antivirals (DAAs) have revolutionized hepatitis C (HCV) treatment with >90% cure rates even in real‐world studies, giving hope that HCV can be eliminated. However, for DAAs to have a population‐level impact on the burden of HCV disease, treatment uptake needs to be expanded. We investigated temporal trends in HCV treatment uptake and evaluated factors associated with second‐generation DAA initiation and efficacy among key HIV‐HCV co‐infected populations in Canada. Methods The Canadian HIV‐HCV Co‐Infection Cohort Study prospectively follows 1699 participants from 18 centres. Among HCV RNA+ participants, we determined the incidence of HCV treatment initiation per year overall and by key populations between 2007 and 2015. Key populations were based on World Health Organization (WHO) guidelines including: people who actively inject drugs (PWID) (reporting injection drug use, last 6 months); Indigenous people; women and men who have sex with men (MSM). Multivariate Cox models were used to estimate adjusted hazard ratios (aHR) and 2‐year probability of initiating second‐generation DAAs for each of the key populations. Results Overall, HCV treatment initiation rates increased from 8 (95% CI, 6–11) /100 person‐years in 2013 to 28 (95% CI, 23–33) /100 person‐years in 2015. Among 911 HCV RNA + participants, there were 202 second‐generation DAA initiations (93% with interferon‐free regimens). After adjustment (aHR, 95% CI), active PWID (0.60, 0.38–0.94 compared to people not injecting drugs) and more generally, people with lower income (<$18 000 CAD/year) (0.50, 0.35, 0.71) were less likely to initiate treatment. Conversely, MSM were more likely to initiate 1.95 (1.33, 2.86) compared to heterosexual men. In our cohort, the population profile with the lowest 2‐year probability of initiating DAAs was Indigenous, women who inject drugs (5%, 95% CI 3–8%). Not having any of these risk factors resulted in a 35% (95% CI 32–38%) probability of initiating DAA treatment. Sustained virologic response (SVR) rates were >82% in all key populations. Conclusion While treatment uptake has increased with the availability of second‐generation DAAs, marginalized populations, already engaged in care, are still failing to access treatment. Targeted strategies to address barriers are needed to avoid further health inequities and to maximize the public health impact of DAAs.
Collapse
Affiliation(s)
- Sahar Saeed
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.,Division of Infectious Diseases/Chronic Viral Illness Service, Department of Medicine, Glen site, McGill University Health Centre, Montreal, QC, Canada
| | - Erin C Strumpf
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.,Department of Economics, McGill University, Montreal, QC, Canada
| | - Erica Em Moodie
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Jim Young
- Division of Infectious Diseases/Chronic Viral Illness Service, Department of Medicine, Glen site, McGill University Health Centre, Montreal, QC, Canada
| | - Roy Nitulescu
- Division of Infectious Diseases/Chronic Viral Illness Service, Department of Medicine, Glen site, McGill University Health Centre, Montreal, QC, Canada
| | - Joseph Cox
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.,Division of Infectious Diseases/Chronic Viral Illness Service, Department of Medicine, Glen site, McGill University Health Centre, Montreal, QC, Canada
| | | | - Sharon Walmsely
- University Health Network, Toronto, ON, Canada.,CIHR Canadian HIV Trials Network, Vancouver, BC, Canada
| | - Curtis Cooper
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Mark Hull
- Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Brian Conway
- Vancouver Infectious Diseases Centre, Vancouver, BC, Canada
| | - Marina B Klein
- Division of Infectious Diseases/Chronic Viral Illness Service, Department of Medicine, Glen site, McGill University Health Centre, Montreal, QC, Canada.,CIHR Canadian HIV Trials Network, Vancouver, BC, Canada
| | | |
Collapse
|
18
|
Aibibula W, Cox J, Hamelin AM, Moodie EEM, Anema A, Klein MB, Brassard P. Association between depressive symptoms, CD4 count and HIV viral suppression among HIV-HCV co-infected people. AIDS Care 2018; 30:643-649. [PMID: 29374972 DOI: 10.1080/09540121.2018.1431385] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Depressive symptoms are associated with poor HIV viral control and immune recovery among people living with HIV. However, no prior studies assessed this association exclusively among people co-infected with HIV-hepatitis C virus (HCV). While people with HIV only and those with HIV-HCV co-infection share many characteristics, co-infected people may become more susceptible to the effects of depressive symptoms on health outcomes. We assessed this association exclusively among people co-infected with HIV-HCV in Canada using data from the Food Security & HIV-HCV Sub-Study (FS Sub-Study) of the Canadian Co-Infection Cohort (CCC). Stabilized inverse probability weighted marginal structural model was used to account for potential time-varying confounders. A total of 725 participants were enrolled between 2012 and 2015. At baseline, 52% of participants reported depressive symptoms, 75% had undetectable HIV viral load, and median CD4 count was 466 (IQR 300-665). People experiencing depressive symptoms had 1.32 times (95% CI: 1.07, 1.63) the risk of having detectable HIV viral load, but had comparable CD4 count to people who did not experience depressive symptoms (fold change of CD4 = 0.96, 95% CI: 0.91, 1.03). Presence of depressive symptoms is a risk factor for incomplete short-term HIV viral suppression among people co-infected with HIV-HCV. Therefore, depressive symptoms screening and related counseling may improve HIV related health outcomes and reduce HIV transmission.
Collapse
Affiliation(s)
- Wusiman Aibibula
- a Department of Epidemiology, Biostatistics and Occupational Health , McGill University , Montreal , QC , Canada
| | - Joseph Cox
- a Department of Epidemiology, Biostatistics and Occupational Health , McGill University , Montreal , QC , Canada.,b Public Health Department , CIUSSS du Centre-Est-de-l 'Ile-de-Montréal , Montréal , QC , Canada.,c Centre for Outcomes Research & Evaluation , Research Institute of the McGill University Health Centre , Montreal , QC , Canada
| | - Anne-Marie Hamelin
- a Department of Epidemiology, Biostatistics and Occupational Health , McGill University , Montreal , QC , Canada
| | - Erica E M Moodie
- a Department of Epidemiology, Biostatistics and Occupational Health , McGill University , Montreal , QC , Canada
| | - Aranka Anema
- d Department of Pediatrics, Harvard Medical School , Harvard University , Boston , MA , USA.,e Department of Medicine , Boston Children's Hospital , Boston , MA , USA.,f Department of Food, Nutrition and Health, Faculty of Land and Food Systems , University of British Columbia , Vancouver , BC , Canada
| | - Marina B Klein
- a Department of Epidemiology, Biostatistics and Occupational Health , McGill University , Montreal , QC , Canada.,g Department of Medicine , McGill University , Montreal , QC , Canada
| | - Paul Brassard
- a Department of Epidemiology, Biostatistics and Occupational Health , McGill University , Montreal , QC , Canada.,c Centre for Outcomes Research & Evaluation , Research Institute of the McGill University Health Centre , Montreal , QC , Canada.,g Department of Medicine , McGill University , Montreal , QC , Canada
| | | |
Collapse
|
19
|
McLinden T, Moodie EEM, Hamelin AM, Harper S, Walmsley SL, Paradis G, Aibibula W, Klein MB, Cox J. Injection Drug Use, Unemployment, and Severe Food Insecurity Among HIV-HCV Co-Infected Individuals: A Mediation Analysis. AIDS Behav 2017; 21:3496-3505. [PMID: 28726043 DOI: 10.1007/s10461-017-1850-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Severe food insecurity (FI), which indicates reduced food intake, is common among HIV-hepatitis C virus (HCV) co-infected individuals. Given the importance of unemployment as a proximal risk factor for FI, this mediation analysis examines a potential mechanism through which injection drug use (IDU) is associated with severe FI. We used biannual data from the Canadian Co-infection Cohort (N = 429 with 3 study visits, 2012-2015). IDU in the past 6 months (exposure) and current unemployment (mediator) were self-reported. Severe FI in the following 6 months (outcome) was measured using the Household Food Security Survey Module. An overall association and a controlled direct effect were estimated using marginal structural models. Among participants, 32% engaged in IDU, 78% were unemployed, and 29% experienced severe FI. After adjustment for confounding and addressing censoring through weighting, the overall association (through all potential pathways) between IDU and severe FI was: risk ratio (RR) = 1.69 (95% confidence interval [CI] = 1.15-2.48). The controlled direct effect (the association through all potential pathways except that of unemployment) was: RR = 1.65 (95% CI = 1.08-2.53). We found evidence of an overall association between IDU and severe FI and estimated a controlled direct effect that is suggestive of pathways from IDU to severe FI that are not mediated by unemployment. Specifically, an overall association and a controlled direct effect that are similar in magnitude suggests that the potential impact of IDU on unemployment is not the primary mechanism through which IDU is associated with severe FI. Therefore, while further research is required to understand the mechanisms linking IDU and severe FI, the strong overall association suggests that reductions in IDU may mitigate severe FI in this vulnerable subset of the HIV-positive population.
Collapse
|
20
|
Aibibula W, Cox J, Hamelin AM, Moodie E, Naimi AI, McLinden T, Klein MB, Brassard P. Food insecurity may lead to incomplete HIV viral suppression and less immune reconstitution among HIV/hepatitis C virus-coinfected people. HIV Med 2017; 19:123-131. [PMID: 29094807 DOI: 10.1111/hiv.12561] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The aim of this study was to determine the impact of food insecurity (FI) on HIV viral load and CD4 count among people coinfected with HIV and hepatitis C virus (HCV). METHODS This study was conducted using data from the Food Security & HIV-HCV Sub-Study of the Canadian Co-Infection Cohort study. FI was measured using the adult scale of Health Canada's Household Food Security Survey Module and was classified into three categories: food security, moderate food insecurity and severe food insecurity. The association between FI, HIV viral load, and CD4 count was assessed using a stabilized inverse probability weighted marginal structural model. RESULTS A total of 725 HIV/HCV-coinfected people with 1973 person-visits over 3 years of follow-up contributed to this study. At baseline, 23% of participants experienced moderate food insecurity and 34% experienced severe food insecurity. The proportion of people with undetectable HIV viral load was 75% and the median CD4 count was 460 [interquartile range (IQR): 300-665] cells/μL. People experiencing severe food insecurity had 1.47 times [95% confidence interval (CI): 1.14, 1.88] the risk of having detectable HIV viral load and a 0.91-fold (95% CI: 0.84, 0.98) increase in CD4 count compared with people who were food secure. CONCLUSIONS These findings provide evidence of the negative impact of food insecurity on HIV viral load and CD4 count among HIV/HCV-coinfected people.
Collapse
Affiliation(s)
- W Aibibula
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - J Cox
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Department of Medicine, McGill University, Montreal, QC, Canada
| | - A-M Hamelin
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Eem Moodie
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - A I Naimi
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - T McLinden
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - M B Klein
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Department of Medicine, McGill University, Montreal, QC, Canada
| | - P Brassard
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Department of Medicine, McGill University, Montreal, QC, Canada.,Center for Clinical Epidemiology, Jewish General Hospital, Montreal, QC, Canada
| |
Collapse
|
21
|
Andreoni M, Babudieri S, Bruno S, Colombo M, Zignego AL, Di Marco V, Di Perri G, Perno CF, Puoti M, Taliani G, Villa E, Craxì A. Current and future challenges in HCV: insights from an Italian experts panel. Infection 2017; 46:147-163. [PMID: 29098647 DOI: 10.1007/s15010-017-1093-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 10/25/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND The recent availability of direct acting antiviral drugs (DAAs) has drastically changed hepatitis C virus (HCV) treatment scenarios, due to the exceedingly high rates of sustained virological response (SVR) and excellent tolerability allowing for treatment at all disease stages. METHODS A panel of Italian experts was convened twice, in November 2016 and January 2017, to provide further support on some open issues and provide guidance for personalized HCV care, also in light of forthcoming regimens. RESULTS AND CONCLUSIONS Treatment recommendations issued by international and national liver societies to guide clinicians in the management of HCV infection are constantly updated due to accumulating new data. Such recommendations may not be applicable to all healthcare settings for a variety of reasons. Moreover, some gaps still remain and the spectrum of patients to be treated is also evolving.
Collapse
Affiliation(s)
- Massimo Andreoni
- Infectious Diseases, Polyclinic of Rome Tor Vergata, Rome, Italy
| | - Sergio Babudieri
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Savino Bruno
- Humanitas University and Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Massimo Colombo
- Humanitas Clinical and Research Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Anna L Zignego
- Department of Experimental and Clinical Medicine, Interdepartmental Centre MASVE, University of Florence, Florence, Italy
| | - Vito Di Marco
- Sezione di Gastroenterologia e Epatologia, DiBiMIS, University of Palermo, Palermo, Italy
| | - Giovanni Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Carlo F Perno
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Massimo Puoti
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Gloria Taliani
- Infectious and Tropical Diseases Unit, Umberto I Hospital-"Sapienza" University, Rome, Italy
| | - Erica Villa
- Department of Internal Medicine, Gastroenterology Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Antonio Craxì
- Gastroenterology and Liver Unit, DiBiMIS, University of Palermo, Palermo, Italy.
| |
Collapse
|