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Care Services for HCV/HIV Coinfected
Reported by Jules Levin
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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.
SURVIVAL IN HCV/HIV CO-INFECTED PATIENTS
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.
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