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Summary

Background

True treatment rates and the impact of comorbidities on treatment rates for hepatitis C virus in the HCV–HIV-coinfected subjects are unknown.

Aim

To quantify the rates of treatment prescription and the effect of comorbidities on hepatitis C virus treatment rates in HCV–HIV-coinfected veterans.

Methods

The Veterans Affairs National Patient Care Database was used to identify all hepatitis C virus-infected subjects between 1999 and 2003 using ICD-9 codes. Demographics, comorbidities and pharmacy data were retrieved. We used logistic regression to compare the predictors of hepatitis C virus treatment in hepatitis C virus-monoinfected and HCV–HIV-coinfected subjects.

Findings

We identified 120 507 hepatitis C virus-infected subjects, of which 6502 were HIV coinfected. 12% of the hepatitis C virus-monoinfected and 7% of the -coinfected subjects were prescribed hepatitis C virus treatment (P < 0.0001). Those not prescribed treatment were older (48.6 years vs. 47.7 years, P = 0.007) and more likely to be black (52% vs. 32%, P < 0.0001). HIV coinfected was less likely to be prescribed hepatitis C virus treatment (OR 0.74, 95% CI: 0.67–0.82). Among the coinfected subjects, the following were associated with non-treatment (OR, 95% CI): black race (0.45, 0.35–0.57); Hispanic race (0.56, 0.38–0.82); drug use (0.68, 0.53–0.88); anaemia (0.17, 0.11–0.26); bipolar disorder (0.63, 0.40–0.99); major depression (0.72, 0.53–0.99); mild depression (0.47, 0.35–0.62).

Conclusions

A small number of HCV–HIV-coinfected veterans are prescribed treatment for hepatitis C virus. Non-treatment is associated with increasing age, minority race, drug use and psychiatric illness. Further studies are needed to determine the eligibility for treatment and reasons for non-treatment for hepatitis C virus.