Patient and physician barriers to HCV treatment in HIV-HCV coinfected individuals: results from ANRS CO13 HEPAVIH cohort
HCV treatment is a major therapeutic opportunity in HIV-HCV infected patients, it
is still unknown to what extent patient beliefs and physician characteristics
may influence HCV treatment initiation decisions. We used longitudinal data from
HEPAVIH ANRS-CO13 to disentangle the effect of clinical, physician and
patient related factors from the decision to start HCV treatment.
Methods: Among the 1040 patients enrolled in the cohort, only pegylated interferon and ribavirin naïve individuals were included. Patients with contraindications to HCV treatment (decompensated cirrhosis, transplantation or hepatocellular carcinoma) were excluded. Medical data were retrieved from hospital records while a self-administered questionnaire for physicians and patients collected socio-demographic, psychosocial and behavioral data. Access to HCV treatment was defined as any prescription of pegylated interferon and ribavirin in the first three years after enrolment in the cohort. A logistic regression was used in order to study the influence of baseline characteristics on access to HCV treatment.
Results: The 600 patients included had a median [IQR] follow-up duration of 12 months [12-24] and 124 (20.7%) started HCV treatment within the first 3 years of the cohort follow-up. HCV treatment incidence was 15 cases per 100 person-years.
After adjustment for age (OR[95%CI]: 0.67[0.48-0.96]), having children (0.61[0.38-0.98]), years since HIV-positive test (0.62 [0.44-0.88]) and severe fibrosis (3.17[1.95-5.15]), negative beliefs about HCV treatment effectiveness/toxicity (0.64[0.39-1.00]) and having a primary physician not involved in HCV care (0.51[0.29-0.91]) were both identified as barriers to HCV treatment.
Conclusions: Access to HCV treatment is influenced not only by clinical characteristics but also by physicians' experience and patients' beliefs about treatment effectiveness and toxicity. Improved communication between patients and their physicians about the degree and durability of HCV treatment benefits and the management of possible side-effects is a priority especially in patients bearing the burden of a double chronic infection.
D. Salmon1,2, J. Cohen3,4,5, M. Winnock6, E. Pambrun6, V. Villes3,4,5, F. Bani-Sadr7,8, E. Rosenthal9, K. Lacombe10,11,12, I. Poizot-Martin13, C. Duvivier14, M.-A. Loko6, P. Sogni15,16, C. Katlama17, F. Dabis6, B. Spire3,4,5, M.P. Carrieri3,4,5, and the HEPAVIH Study Group
1Université Paris-Sud et Université Paris Descartes, UMR-S0669, Paris, France, 2Hôpital Cochin Port-Royal, Paris, France, 3INSERM, U912 (SE4S), Marseille, France, 4Université Aix Marseille, IRD, UMR-S912, Marseille, France, 5ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France, 6INSERM U897, ISPED, Université Victor Ségalen, Bordeaux, France, 7Groupe Hospitalier Universitaire Est- Hôpital Tenon, Paris, France, 8INSERM U 707, Université Pierre et Marie Curie (UPMC-Paris 6), Paris, France, 9CHU Nice, Nice, France, 10AP-HP, Hôpital Saint-Antoine, Paris, France, 11INSERM UMR-S707, Paris, France, 12UPMC, Paris VI, Paris, France, 13CHU Sainte Marguerite, Marseille, France, 14Service des Maladies Infectieuses et Tropicales, Hôpital la Pitié-Salpêtrière, Paris, France, 15Université Paris Descartes, Paris, France, 16Unité d'hépatologie, Hôpital Cochin, Paris, France, 17Service des Maladies Infectieuses et Tropicales, Hôpital La Pitié-Salpêtrière, Paris, France