Disparities in Treatment with Direct-Acting Hepatitis C Virus Antivirals Persist Among Adults Coinfected with HIV and Hepatitis C Virus in US Clinics, 2010-2018.

Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) coinfection carries substantial risk for all-cause mortality and liver-related morbidity and mortality, yet many persons coinfected with HIV/HCV remain untreated for HCV. We explored demographic, clinical, and sociodemographic factors among participants in routine HIV care associated with prescription of direct-acting antivirals (DAAs). The HIV Outpatient Study (HOPS) is an ongoing longitudinal cohort study of persons with HIV in care at participating clinics since 1993. There are currently eight study sites in six US cities. We analyzed medical records data of HOPS participants diagnosed with HCV since June 2010. Sustained virological response (SVR) was documented with first undetectable HCV viral load (VL). We assessed factors associated with being prescribed DAAs by multi-variable logistic regression and described the cumulative rate of SVR. Among 306 eligible participants, 131 (43%) were prescribed DAA therapy. Factors associated with greater odds of being prescribed DAA were older age, private health insurance, higher CD4 cell count, being a person who injects drugs, and receiving care at publicly funded sites (p < 0.05). Of 127 (97%) participants with at least 1 follow-up HCV VL, 110 (87%) achieved SVR at 12 weeks. Of the total 131 participants, 123 (94%) eventually achieved SVR. Less than half of HIV/HCV coinfected patients in HOPS have been prescribed DAAs. Interventions are needed to address deficits in DAA prescription, including among patients with public or no health insurance, younger age, and lower CD4 cell count.

Hepatitis C Update and Expanding the Role of Primary Care.

Primary care physicians (PCPs) are increasing their role in the fight against the Hepatitis C Virus (HCV). Approximately 3.5 million Americans currently live with chronic HCV with rising incidence among young persons, especially those affected by the opioid epidemic. Online guidelines and drug interaction checkers streamline treatment and increase accessibility for both patients and providers. Although treatment with new Direct Acting Antiviral agents ensure cure rates that routinely exceed 95%, as well as cause fewer adverse effects than previously available interferon-based regimens, some states still restrict access to HCV treatment, including by mandating which providers can prescribe and treat HCV. This special communication reviews HCV treatment resources, discusses data demonstrating similar cure rates between PCPs and specialists, and argues that capacity-building among PCPs will be necessary to control the HCV epidemic.

HIV and HCV screening among trauma patients.

The purpose of this study was to develop a hepatitis C virus (HCV) and HIV screening program for patients evaluated by the trauma service and link to care. Patients were offered screening for HCV antibody and HIV. Demographics were collected on gender, race, age, and history of intravenous drug use. A navigator connected patients to treatment. In total, 1160 trauma patients were screened for HCV and/or HIV. There were 162 (14%) patients with HCV antibodies. Patients who inject drugs comprised 39.5% (64) of the HCV antibody positive group. Forty-six (68.7%) patients received linkage to care services and 55 (34%) patients were actively engaged in treatment. There were 155 (10.5%) of all eligible patients screened for HIV. Twenty-one (13.5%) patients were living with HIV (PLWH) and there were two (1.3%) new HIV infections. All new PLWH were linked to care and a total of 14 (73.7%) PLWH were on antiretroviral therapy. This is the first HCV and HIV screening and linkage to care program of trauma surgery patients. In this interim program evaluation, we found high prevalence of HCV antibody and HIV prevalence and high linkage to care rates. Trauma service HCV and HIV screening is an opportunity to diagnose, link, and re-engage a vulnerable population.

HIV Pre-Exposure Prophylaxis and Women: Survey of the Knowledge, Attitudes, and Beliefs in an Urban Obstetrics/Gynecology Clinic.

Uptake of HIV pre-exposure prophylaxis (PrEP) is low among women at risk for HIV acquisition. Of 468,000 women, whom the United States Centers for Disease Control and Prevention estimates to be eligible for PrEP, only 10,000 unique women have begun therapy through the third quarter of 2015. These data suggest insufficient HIV prevention efforts. This study, conducted at the site of an urban academic medical center with an emergency department HIV prevalence rate of 4%, assesses the knowledge, attitudes, and beliefs of women toward PrEP. A self-administered survey was conducted among women at a family planning obstetrics/gynecology clinic at Temple University Hospital (Philadelphia, PA). Participants assessed their HIV acquisition risk and answered eight questions regarding knowledge, attitudes, and beliefs toward PrEP. Three hundred eighty-nine surveys met inclusion criteria. Sixty-five percent of women were black, and 73% were between 18 and 33 years of age. The median self-perceived risk score was 0 (interquartile range = 2) using a Likert scale. Thirty-three percent of women believed that PrEP could work, and 27% knew that such a regimen existed. Concerns existed toward cost (44%) and side effects (39%). Fifty-seven percent of women surveyed stated that they would take a medication to prevent HIV, and 64% felt comfortable discussing the subject with her doctor. Our data demonstrate a lack of PrEP knowledge, although willingness for uptake among women at risk for HIV acquisition, and a need for directed education and outreach.

Reducing False-Positive HIV Diagnosis in Niger: A Women's Issue.

The entry into both HIV care and secondary prevention is first through the knowledge of one's own HIV status. Testing for HIV remains challenging in countries where clinicians rely on rapid testing algorithms because the routine use of confirmatory Western blot technology is unavailable. In this case report, we describe the case of a pregnant woman in Niger, who was falsely labeled as HIV positive during prenatal visits. We also describe our clinical algorithm that was developed to facilitate retesting in patients who initially tested HIV positive or indeterminant with rapid diagnostic tests. Vigilance is necessary to ensure that appropriate identification and treatment of HIV is provided to reduce mother-to-child transmission of HIV, to appropriately allocate resources, and to avoid falsely labeling patients with HIV.