首页>
外文期刊>Open Forum Infectious Diseases
>Hepatitis C Care Continuum in a Human Immunodeficiency Virus (HIV) Positive Cohort: Data From the HIV Atlanta Veterans Affairs Cohort Study
【24h】
Hepatitis C Care Continuum in a Human Immunodeficiency Virus (HIV) Positive Cohort: Data From the HIV Atlanta Veterans Affairs Cohort Study
BackgroundHuman immunodeficiency virus (HIV) and hepatitis C virus (HCV) coinfection is associated with accelerated progression to cirrhosis, end-stage liver disease, and liver-associated death. It is fortunate that curative direct-acting antivirals for the treatment of HCV are widely available in the VA healthcare system. We attempted to identify, evaluate, and treat all HIV/HCV-coinfected persons at the Atlanta VA Healthcare System.MethodsHuman immunodeficiency virus/HCV-coinfected persons at Atlanta VA between 2015 and 2018 were identified using the HIV Atlanta Veterans Affairs Cohort Study and Hepatitis C VA Clinical Case Registry. Retrospective reviews of each electronic medical record were conducted by the hepatitis C clinical team for validation. The primary end point was achieving sustained virologic response.ResultsOne hundred thirty-eight veterans with HIV and hepatitis C viremia were identified. One hundred twenty-five (90%) were evaluated for treatment and 113 (91%) were initiated on direct-acting antiviral therapy. Median age at initiation of treatment was 60 years and the majority were black race (90%). Genotype 1a was most common (70%) and 41% had compensated cirrhosis. One hundred eight completed treatment and 96% achieved sustained virologic response. Six veterans had virologic relapse; 4 had treatment-emergent resistance mutations in the NS5a gene. Mean CD4 was 580 cells/mm3 with HIV viral suppression in 82% of the cohort. In those not treated, unstable housing (25%), active substance use (31%), and psychiatric conditions (42%) were identified barriers to care.ConclusionsThrough a concerted, systematic effort, over 80% of HIV/hepatitis C persons in the Atlanta VA have been initiated on treatment for hepatitis C, 96% of which have been cured.
展开▼
机译：背景生免疫缺陷病毒（HIV）和丙型肝炎病毒（HCV）繁殖与加速进展与肝硬化，终末期肝病和肝相关的死亡有关。幸运的是，用于治疗HCV的治疗直接行动抗病毒品在VA医疗保健系统中广泛使用。我们试图识别，评估和治疗Atlanta VA Healthcare System的所有艾滋病毒/ HCV-繁殖的人。使用艾滋病毒亚特兰大退伍军人事务队列和肝炎鉴定了2015年至2018年间亚特兰大VA的亚特兰大VA的免疫缺陷病毒/ HCV-繁殖人员C VA临床案例注册处。对每个电子病历的回顾性评论由丙型肝炎临床团队进行验证。主要终点达到持续的病毒学反应。鉴定了百六十八位与艾滋病毒和丙型肝炎病毒症的退伍军人。评估一百二十五（90％）进行治疗，并在直接作用抗病毒治疗开始113（91％）。治疗开始的中位年龄为60年，大多数是黑色比赛（90％）。基因型1A最常见（70％），41％已得到补偿肝硬化。一百八个完成的治疗和96％取得了持续的病毒学反应。六位退伍军人有病毒学复发; 4在NS5A基因中具有治疗急性抗性突变。平均CD4为580个细胞/ mm 3，占占队的82％的艾滋病病毒抑制。在那些未治疗的人中，确定了不稳定的住房（25％），活性物质（31％）和精神病条件（42％）被确定为护理壁垒。结论一致，系统努力，超过80％的艾滋病毒/丙型肝炎亚特兰达VA已启动对丙型肝炎的治疗，其中96％已被治愈。
展开▼
