Implementing a Comprehensive Hepatitis C Virus (HCV) Clinic Within a Human Immunodeficiency Virus Clinic: A Model of Care for HCV Microelimination

Abstract Background Among the 1.2 million people with human immunodeficiency virus (HIV) in the United States, 25% are coinfected with hepatitis C virus (HCV). The availability of effective direct acting antivirals (DAAs) makes the goal of HCV elimination feasible, but implementation requires improvements to the HCV treatment cascade, especially linkage to and initiation of treatment in underserved populations. Methods In this retrospective review, a cohort of patients receiving care at a hospital-based HIV clinic in New Haven, Connecticut (January 1, 2014–March 31, 2017) with chronic HCV infection not previously treated with DAAs were followed longitudinally. Patients were referred to a colocated multidisciplinary team. Standardized referral and treatment algorithms and electronic medical record templates were developed, monthly meetings were held, and a registry was created to review progress. Results Of 173 patients, 140 (80.9%) were 50–70 years old, 115 (66.5%) were male, 99 (57.2%) were African American, 43 (24.9%) were white, and 23 (13.3%) were Hispanic. Comorbidities included the following: cirrhosis (25.4%), kidney disease (17.3%), mental health issues (60.7%), alcohol abuse (30.6%), and active drug use (54.3%). Overall, 161 (93.1%) were referred, 147 (85%) were linked, 122 (70.5%) were prescribed DAAs, and 97 (56.1%) had sustained viral response at 12 weeks posttreatment or cure (SVR12). Comparison between those with SVR12 and those unsuccessfully referred, linked, or treated, showed that among those not engaged in HCV care, there was a higher proportion of younger (mean age 54.2 vs 57 years old, P = .022), female patients (P = .001) and a higher frequency of missed appointments. Conclusions Establishing a colocated HCV clinic within an HIV clinic resulted in treatment initiation in 70.5% of patients and SVR12 in 56.1%. This success in a hard-to-treat population is a model for achieving microelimination goals set by the World Health Organization.

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1065. Hepatitis C Virus Care Cascade Assessment–One Step Closer to Micro-Elimination

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1251 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S561-S562

Author(s):

Jehan F Chowdhury ◽

Anna Winston ◽

Tanya Zeina ◽

Hong Gi Shim ◽

Tine Vindenes

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Drug Use ◽

Sustained Viral Response ◽

The United States ◽

World Health ◽

Viral Response ◽

Care Cascade ◽

Care Gaps ◽

Hcv Antibody

Abstract Background Hepatitis C virus (HCV) is a leading cause of advanced liver disease and death. In the United States about 3.5 million people are living with HCV, but only 50% are aware of the infection, 16% are prescribed treatment, and only 9% achieve sustained viral response. The World Health Organization published an HCV elimination goal for 2030 that strives to achieve a 65% reduction in HCV-related deaths and 90% reduction in transmission. An important step toward this goal is micro-elimination at local hospitals by addressing care gaps in the HCV care cascade. Figure 1 Methods We created a retrospective cohort of patients who tested positive for HCV antibody (HCV Ab+) between 2016 and 2018 at Tufts Medical Center in Boston, Massachusetts. We assessed achievement of care cascade steps including HCV viral load (VL) testing, linkage to care, treatment initiation, and sustained viral response (SVR). We also assessed patient demographics, clinical factors and HCV risk factors. We used STATA/IC 14.1 to conduct bivariate analysis to identify factors associated with loss to follow-up across each care cascade step. Results A total of 24,308 HCV antibody tests were done during this timeframe, of which 5% (n=1,222) were HCV Ab+. After excluding duplicate tests, 1,041 unique patients with HCV Ab+ were included. This cohort had a mean age of 47 years and were 61% male, 66% white, 72% on public insurance, 12% HIV-positive, 13% HCV treatment-experienced. The most frequent HCV risk factor was injection drug use, occurring in 64% of patients. Of patients with HCV Ab+, 76% (n=791) were tested for an HCV VL, of which 50% (n=393) had detectable VL and 50% (n=398) had undetectable VL. Of the patients with a detectable VL, 58% (n=226) were linked with care. Following care linkage, 69% (n=155) initiated treatment, of which 90% (n=139) completed treatment, of which 97% (n=135) achieved SVR (Figure 1). Factors that were significantly associated with getting a VL test and linking to care included private insurance, HIV co-infection, absence of intravenous drug use and cirrhosis; however, these factors were not significantly associated with achieving subsequent steps. Conclusion Assessment of the HCV care cascade at our hospital allowed us to identify clear care gaps and areas needing improvement towards a local micro-elimination. Disclosures All Authors: No reported disclosures

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Eliminating Hepatitis C Virus Among Human Immunodeficiency Virus–Infected Men Who Have Sex With Men in Berlin: A Modeling Analysis

The Journal of Infectious Diseases ◽

10.1093/infdis/jiz367 ◽

2019 ◽

Vol 220 (10) ◽

pp. 1635-1644 ◽

Cited By ~ 9

Author(s):

Natasha K Martin ◽

Klaus Jansen ◽

Matthias an der Heiden ◽

Christoph Boesecke ◽

Anders Boyd ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Behavioral Interventions ◽

Scale Up ◽

World Health ◽

Transmission Model ◽

Immunodeficiency Virus ◽

Hcv Transmission ◽

Sex With Men

Abstract Background Despite high hepatitis C virus (HCV) treatment rates, HCV incidence among human immunodeficiency virus (HIV)–infected men who have sex with men (HIV-infected MSM) in Germany rose before HCV direct-acting antivirals (DAAs). We model what intervention can achieve the World Health Organization (WHO) elimination target of an 80% reduction in HCV incidence by 2030 among HIV-infected MSM in Berlin. Methods An HCV transmission model among HIV-diagnosed MSM was calibrated to Berlin (rising HCV incidence and high rates of HCV testing and treatment). We modeled the HCV incidence among HIV-diagnosed MSM in Berlin until 2030 (relative to 2015 WHO baseline) under scenarios of DAA scale-up with or without behavior change (among HIV-diagnosed MSM and/or all MSM). Results Continuing current treatment rates will marginally reduce the HCV incidence among HIV-diagnosed MSM in Berlin by 2030. Scaling up DAA treatment rates, beginning in 2018, to 100% of newly diagnosed HCV infections within 3 months of diagnosis and 25% each year of previously diagnosed and untreated HCV infections could reduce the HCV incidence by 61% (95% confidence interval, 55.4%–66.7%) by 2030. The WHO target would likely be achieved by combining DAA scale-up with a 40% reduction in HCV transmission among HIV-diagnosed MSM and a 20% reduction among HIV-undiagnosed or HIV-uninfected MSM. Discussion HCV elimination among HIV-infected MSM in Berlin likely requires combining DAA scale-up with moderately effective behavioral interventions to reduce risk among all MSM.

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Patterns of Healthcare Utilization Among Veterans Infected With Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) and Coinfected With HIV/HCV: Unique Burdens of Disease

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw173 ◽

2016 ◽

Vol 3 (3) ◽

Cited By ~ 6

Author(s):

Shereen Katrak ◽

Lawrence P. Park ◽

Christopher Woods ◽

Andrew Muir ◽

Charles Hicks ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Hospital Admission ◽

Healthcare System ◽

Healthcare Utilization ◽

The United States ◽

Psychiatric Disease ◽

Immunodeficiency Virus ◽

Ed Visits

Abstract Background. Hepatitis C virus (HCV) infection is a leading cause of cirrhosis and the primary cause of liver transplantation in the United States, and coinfection with human immunodeficiency virus (HIV) increases the risk of comorbidities. However, healthcare utilization (HCU) patterns among HIV/HCV-coinfected patients are poorly understood. This study compared the rates of HCU and reasons for hospital admission among HCV-infected, HIV-infected, and HIV/HCV-coinfected veterans. Methods. Hepatitis C virus- and HIV-infected and HIV/HCV-coinfected veterans in care with the Department of Veterans Affairs (VA) from 1998 to 2009 (n = 335 371, n = 28 179, n = 13 471, respectively) were identified by HIV- and HCV-associated International Classification of Diseases, Ninth Revision codes from the clinical case registry. We assessed rates of HCU using emergency department (ED) visits, outpatient visits, and hospitalization and primary diagnoses associated with hospitalization. Independent risk factors associated with hospitalization were also examined. Results. Rates of outpatient and ED visits increased over the 11-year study period for all groups, with inpatient admission rates remaining stable. The HCU rates were consistently higher for the coinfected than other cohorts. The primary reason for hospital admission for all groups was psychiatric disease/substance use, accounting for 44% of all admissions. Nadir CD4 <350 cells/mm3 was associated with higher rates of hospitalization versus nadir CD4 >500 cells/mm3. Conclusions. As the current population of HCV-infected, HIV-infected, and HIV/HCV-coinfected veterans age, they will continue to place a substantial and increasing demand on the US healthcare system, particularly in their utilization of ED and outpatient services. These data suggest the need for an ongoing investment in mental health and primary care within the VA healthcare system.

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Evaluation Of Outpatient Health Care And Medication Utilization In Patients With Human Immunodeficiency Virus/Hepatitis C Virus (Hiv/Hcv), Hiv, Or Hcv Infection In The United States

Value in Health ◽

10.1016/j.jval.2013.03.1097 ◽

2013 ◽

Vol 16 (3) ◽

pp. A216

Author(s):

T. Johnson ◽

J. Toliver ◽

C.U. Oramasionwu

Keyword(s):

United States ◽

Health Care ◽

Human Immunodeficiency Virus ◽

Hepatitis C Virus ◽

Hepatitis C ◽

The United States ◽

Hcv Infection ◽

Virus Hepatitis ◽

Medication Utilization ◽

Immunodeficiency Virus

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Incidence of Hepatitis C Virus Infection in the Human Immunodeficiency Virus Outpatient Study Cohort, 2000–2013

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx076 ◽

2017 ◽

Vol 4 (2) ◽

Cited By ~ 7

Author(s):

Taraz Samandari ◽

Ellen Tedaldi ◽

Carl Armon ◽

Rachel Hart ◽

Joan S. Chmiel ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Hepatitis C Virus ◽

Hepatitis C ◽

The United States ◽

Cox Proportional Hazards ◽

Hcv Infection ◽

Study Cohort ◽

Immunodeficiency Virus ◽

Incident Cases ◽

Outpatient Study

Abstract Background There are few recent studies of incident hepatitis C virus (HCV) infection among human immunodeficiency virus (HIV)-infected patients in the United States. Methods We studied HIV Outpatient Study (HOPS) participants seen in 9 HIV-specialty clinics who had ≥1 clinical encounter during 2000–2013 and ≥2 HCV-related tests, the first of which was a negative HCV antibody test (Ab). Hepatitis C virus incident cases were identified by first positive HCV Ab, viral load, or genotype. We assessed rates of incident HCV overall, by calendar intervals, and by demographic and HIV risk strata, and we explored risk factors for incident HCV using Cox proportional hazards models. Results The 1941 eligible patients (median age 40 years, 23% female, 61% men who had sex with men [MSM], and 3% persons who injected drugs [PWID]) experienced 102 (5.3%) incident HCV infections for an overall incidence of 1.07 (95% confidence interval [CI], 0.87–1.30) per 100 person-years (py). Hepatitis C virus incidence decreased from 1.83 in 2000–2003 to 0.88 in 2011–2013 (P = .024), with decreases observed (P < .05) among PWID and heterosexuals, but not among MSM. Overall, MSM comprised 59% of incident cases, and PWID were at most risk for incident HCV infection (adjusted hazard ratio [aHR] for PWID = 4.62 and 95% CI = 2.11–10.13; for MSM, aHR = 1.48 and 95% CI = 0.86–2.55 compared with heterosexuals). Conclusions Among HIV-infected patients in care during 2000–2013, incidence of HCV infection exceeded 1 case per 100 py. Our findings support recommendations for annual HCV screenings for HIV-infected persons, including persons with only MSM risk, to enable HCV diagnosis and treatment for coinfected individuals.

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Decline in Hepatitis C Virus (HCV) Incidence in Men Who Have Sex With Men Living With Human Immunodeficiency Virus: Progress to HCV Microelimination in the United Kingdom?

Clinical Infectious Diseases ◽

10.1093/cid/ciaa021 ◽

2020 ◽

Cited By ~ 3

Author(s):

Lucy J Garvey ◽

Graham S Cooke ◽

Colette Smith ◽

Christoph Stingone ◽

Indrajit Ghosh ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

United Kingdom ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Incidence Rates ◽

World Health ◽

Immunodeficiency Virus ◽

Acute Hcv ◽

Sex With Men ◽

Living With Hiv

Abstract Background Modeling of the London hepatitis C virus (HCV) epidemic in men who have sex with men (MSM) and are living with human immunodeficiency virus (HIV) suggested that early access to direct-acting antiviral (DAA) treatment may reduce incidence. With high rates of linkage to care, microelimination of HCV within MSM living with HIV may be realistic ahead of 2030 World Health Organization targets. We examined trends in HCV incidence in the pre- and post-DAA eras for MSM living with HIV in London and Brighton, United Kingdom. Methods A retrospective cohort study was conducted at 5 HIV clinics in London and Brighton between 2013 and 2018. Each site reported all acute HCV episodes during the study period. Treatment timing data were collected. Incidence rates and reinfection proportion were calculated. Results A total of 378 acute HCV infections were identified, comprising 292 first infections and 86 reinfections. Incidence rates of acute HCV in MSM living with HIV peaked at 14.57/1000 person-years of follow-up (PYFU; 95% confidence interval [CI], 10.95–18.20) in 2015. Rates fell to 4.63/1000 PYFU (95% CI, 2.60 to 6.67) by 2018. Time from diagnosis to starting treatment declined from 29.8 (2013) to 3.7 months (2018). Conclusions We observed a 78% reduction in the incidence of first HCV episode and a 68% reduction in overall HCV incidence since the epidemic peak in 2015, which coincides with wider access to DAAs in England. Further interventions to reduce transmission, including earlier access to treatment and for reinfection, are likely needed for microelimination to be achieved in this population.

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Cost-Effectiveness of Genotype 1 Chronic Hepatitis C Virus Treatments in Patients Coinfected with Human Immunodeficiency Virus in the United States

Advances in Therapy ◽

10.1007/s12325-016-0362-1 ◽

2016 ◽

Vol 33 (8) ◽

pp. 1316-1330 ◽

Cited By ~ 8

Author(s):

Sammy Saab ◽

Suchin Virabhak ◽

Hélène Parisé ◽

Scott Johnson ◽

Alice Wang ◽

...

Keyword(s):

United States ◽

Human Immunodeficiency Virus ◽

Chronic Hepatitis ◽

Hepatitis C Virus ◽

Cost Effectiveness ◽

Hepatitis C ◽

The United States ◽

Genotype 1 ◽

Immunodeficiency Virus ◽

Chronic Hepatitis C Virus

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Clinical Liver Disease Progression Among Hepatitis C-Infected Drug Users With CD4 Cell Count Less Than 200 Cells/mm3 Is More Pronounced Among Women Than Men

Open Forum Infectious Diseases ◽

10.1093/ofid/ofv214 ◽

2015 ◽

Vol 3 (1) ◽

Cited By ~ 4

Author(s):

Amy S. Baranoski ◽

Deborah Cotton ◽

Timothy Heeren ◽

David Nunes ◽

Rachel W. Kubiak ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Hepatitis C Virus ◽

Liver Disease ◽

Hepatitis C ◽

Disease Progression ◽

Drug Users ◽

White Women ◽

The United States ◽

Liver Disease Progression ◽

Immunodeficiency Virus

Abstract Background. Hepatitis C virus (HCV) infection is a leading cause of liver-related morbidity and mortality in the United States, and injection drug users are at particularly high risk. Methods. This prospective observational cohort study assessed the rate of, and risk factors for, clinical liver disease progression in a cohort of HCV monoinfected and human immunodeficiency virus (HIV)/HCV coinfected drug users using unadjusted and multivariate Cox proportional hazards regression analyses. Results. Of 564 subjects including 421 (75%) with HIV/HCV coinfection and 143 with HCV monoinfection, 55 (10%) had clinical liver disease progression during follow-up with a rate of 25.3 events per 1000 person-years. In unadjusted analysis, there was an interaction between sex and HIV status. In sex-stratified multivariate analysis, HIV/HCV-coinfected women with CD4 <200 cells/mm3 had 9.99 times the risk of liver disease progression as HCV-monoinfected women (confidence interval [CI], 1.84–54.31; P = .008), and white women had a trend towards increased risk of liver disease progression compared with non-white women (hazard ratio, 2.84; CI, .93–8.68; P = .07). Human immunodeficiency virus/HCV-coinfected men with CD4 <200 cells/mm3 had 2.86 times the risk of liver disease progression as HCV-monoinfected men (CI, 1.23-6.65; P = .01). Conclusions. Hepatitis C virus-monoinfected and HIV/HCV-coinfected drug users had high rates of clinical liver disease progression. In those with HIV infection, liver disease progression was associated with advanced immune suppression. This effect was strikingly more pronounced in women than in men.

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