icon_folder.gif   Conference Reports for NATAP  
  AASLD ( American Association for the Study of Liver Diseases)
November 9-13, 2001, Dallas
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Care Services for HCV/HIV Coinfected
Reported by Jules Levin
  I spoke with Dr Hassanein and the nurse coordinator Deanna Oliver here at AASLD and DDW about the program they offer for care for HC/HIV coinfected patients at their clinic. The services they offer and their dedication and skill they provide are a major factor in the success they present in their poster. The poster reports that patients who are compliant have longer survival. By compliance they mean adherence to medications, participating in support group the clinic offers and not missing their clinic visits. Also important to the success of their program is how they provide medical care. The HIV and Hepatitis departments work out of the same offices. When a patient has a visit they see both their HIV and HCV providers during that same visit. The HIV and HCV providers consult to discuss the care of that patient. And it was obvious to me that the providers at this site are invested in this program. The support groups are open to coinfected patients whether or not they are receiving HCV treatment. Both support and education are provided. This type of program is needed to help patients success with complicated therapies for HIV and HCV. But, the providers skills and dedication are key to the success of such a program. Many clinics are more concerned with the acquisition of funding to provide such a program rather than the dedication and skills needed to make the program succeed. Often clinic staff are not willing to take the time needed to make such a program succeed. It also helps if the clinic staff understand HCV therapy and many do not.
Tarek I Hassanein, Nina Aronson, Deanna L Oliver, Ed Barber, Robin C Hilsabeck, Eileen Chatfield, Mari Stewart, Christopher Mathews, Univ of CA, San Diego, San Diego
abstract 234
The impact of HCV infection on survival of HIV patients has been inconsistent. Prior results from our lab suggested that HCV status did not significantly impact survival in HIV patients, while others have shown that HCV status shortens patients' survival. The purpose of the present study was to test the hypothesis that co-infected patients who seek specialized treatment for HCV will have better survival rates than those who do not. Methods: 2969 HIV patients seen over a 5 1/2-year period were included in this study. Mean age of the sample was 40.9 years, and 85% were male. 603 patients were co-infected with HCV. Co-infected patients were divided into two groups, according to compliance with medical care. 62 co-infected patients were judged to be compliant, and 549 were not. A third group was comprised of 2366 HIV-infected patients. To examine group differences in survival, Kaplan Meier and Cox regression stratified by group were used to analyze both unadjusted and adjusted survival distributions. We determined independent risk factors for survival, and variables that were significant were entered as covariates in a multivariate Cox regression. Results: The unadjusted model showed that there was significant difference between the three groups survival functions by log rank test (c2 = 18.43, p = 0.0001). Analyses revealed that the compliant co-infected group had a significantly longer survival rate than both the HIV and non-compliant groups. In turn, the HIV group had a significantly longer survival rate than the non-compliant co-infected group. The hazard ratios were adjusted for demographics (age, race, gender), baseline CD4 and HIV viral load, and time dependant CD4 and HIV viral load, in three separate models. The difference in hazard ratios between the three groups remained consistent in all three models. Thus, even when accounting for these covariates, there were significant group differences in survival rate. Summary: 1) There is a significant difference in survival between the three groups studied. 2) This difference is not a function of demographics, baseline CD4 and HIV viral load, nor time dependant CD4 and HIV viral load. In conclusion, co-infected patients who actively seek specialized care for their HCV infection have significantly better survival rates than patients who do not.