Retrospective Cohort Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Mar 8, 2016; 8(7): 368-375
Published online Mar 8, 2016. doi: 10.4254/wjh.v8.i7.368
Non-initiation of hepatitis C virus antiviral therapy in patients with human immunodeficiency virus/hepatitis C virus co-infection
Christine U Oramasionwu, Angela D M Kashuba, Sonia Napravnik, David A Wohl, Lu Mao, Adaora A Adimora
Christine U Oramasionwu, Angela DM Kashuba, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, United States
Sonia Napravnik, David A Wohl, Angela DM Kashuba, UNC Center for AIDS Research, University of North Carolina, Chapel Hill, NC 27599, United States
Sonia Napravnik, David A Wohl, Adaora A Adimora, Angela DM Kashuba, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, United States
Lu Mao, Adaora A Adimora, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, United States
Author contributions: Oramasionwu CU designed and coordinated the research and wrote the manuscript; Kashuba ADM and Adimora AA help design the research and draft the manuscript; Napravnik S helped design the research and acquire clinical cohort data; Wohl DA helped design the research; Mao L conducted data analysis; all authors approved the final manuscript.
Supported by The University of North Carolina at Chapel Hill Center for AIDS Research (CFAR) an NIH funded program to Dr. Oramasionwu, No. P30 AI50410; Dr. Oramasionwu was also supported partially by the NIH Loan Repayment Program (LRP) through the National Institute on Minority Health and Health Disparities, No. L60 MD003770.
Institutional review board statement: This research was reviewed and approved by the University of North Carolina at Chapel Hill Institutional Review Board.
Informed consent statement: The clinical cohort, approved by the UNC Institutional Review Board, has ongoing enrollment and participants provide written informed consent.
Conflict-of-interest statement: The authors declare no other conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Christine U Oramasionwu, PharmD, PhD, Assistant Professor, UNC Eshelman School of Pharmacy, University of North Carolina, Kerr Hall 2215, Chapel Hill, NC 27599, United States.
Telephone: +1-919-8434071 Fax: +1-919-9668486
Received: August 1, 2015
Peer-review started: August 3, 2015
First decision: September 14, 2015
Revised: October 24, 2015
Accepted: December 3, 2015
Article in press: December 4, 2015
Published online: March 8, 2016

AIM: To assess whether reasons for hepatitis C virus (HCV) therapy non-initiation differentially affect racial and ethnic minorities with human immunodeficiency virus (HIV)/HCV co-infection.

METHODS: Analysis included co-infected HCV treatment-naïve patients in the University of North Carolina CFAR HIV Clinical Cohort (January 1, 2004 and December 31, 2011). Medical records were abstracted to document non-modifiable medical (e.g., hepatic decompensation, advanced immunosuppression), potentially modifiable medical (e.g., substance abuse, severe depression, psychiatric illness), and non-medical (e.g., personal, social, and economic factors) reasons for non-initiation. Statistical differences in the prevalence of reasons for non-treatment between racial/ethnic groups were assessed using the two-tailed Fisher’s exact test. Three separate regression models were fit for each reason category. Odds ratios and their 95%CIs (Wald’s) were computed.

RESULTS: One hundred and seventy-one patients with HIV/HCV co-infection within the cohort met study inclusion. The study sample was racially and ethnically diverse; most patients were African-American (74%), followed by Caucasian (19%), and Hispanic/other (7%). The median age was 46 years (interquartile range = 39-50) and most patients were male (74%). Among the 171 patients, reasons for non-treatment were common among all patients, regardless of race/ethnicity (50% with ≥ 1 non-modifiable medical reason, 66% with ≥ 1 potentially modifiable medical reason, and 66% with ≥ 1 non-medical reason). There were no significant differences by race/ethnicity. Compared to Caucasians, African-Americans did not have increased odds of non-modifiable [adjusted odds ratio (aOR) = 1.47, 95%CI: 0.57-3.80], potentially modifiable (aOR = 0.72, 95%CI: 0.25-2.09) or non-medical (aOR = 0.90, 95%CI: 0.32-2.52) reasons for non-initiation.

CONCLUSION: Race/ethnicity alone is not predictive of reasons for HCV therapy non-initiation. Targeted interventions are needed to improve access to therapy for all co-infected patients, including minorities.

Keywords: Human immunodeficiency virus, Hepatitis C virus, Co-infection, Antiviral therapy, Race

Core tip: Historically, hepatitis C virus (HCV) treatment rates have been low in patients with human immunodeficiency virus (HIV) co-infection, especially for African-American patients. Identifying the reasons for treatment non-initiation may help improve treatment rates among racially and ethnic minorities. In our study of patients with HIV/HCV coinfection, non-modifiable medical reasons, potentially modifiable medical reasons, and non-medical reasons for non-treatment were common among all patients, regardless of their race/ethnicity. There is a need to recognize and overcome potential treatment barriers in order to improve HCV treatment uptake in this patient population.