Coinfection

Factors that Influence the Decision of HIV/HCV Coinfected Patients to Start Treatment for Hepatitis C

It is estimated that nearly 30% of HIV positive people are coinfected with hepatitis C virus (HCV), and liver disease is a leading cause of death in this population. However, only a small number of HIV/HCV coinfected patients receive treatment for hepatitis C due to a variety of factors, according to an article published in the November 22, 2009 online edition of AIDS Patient Care and STDS.

Research indicates that HIV positive individuals with chronic hepatitis C tend to experience more rapid liver disease progression than people with HCV alone, and thus may benefit from earlier hepatitis C treatment. While physicians often are first to recommend treatment, patients must make the final decision about initiating therapy.

Therefore, in the current study, investigators used a process model framework to explore factors that influence patients' treatment decision-making. The authors conducted interviews with 35 HIV/HCV coinfected patients and 11 primary care providers at 3 HIV clinics in Los Angeles.

Results

• Patients reported that the following were key factors influencing treatment decisions:
• Stability of HIV disease;
• Perceived need for HCV treatment;
• Treatment readiness;
• Willingness to deal with side effects;
• Absence of substance abuse;
• Stability of mental health;
• Overall life circumstances.
• Patients also mentioned the positive influence of having a trusting relationship with their provider.
• Clinicians acknowledged an awareness of the influence of how they present the risks and benefits of HCV treatment and the overall tone of their recommendation (encouraging, dissuasive, or neutral).

In conclusion, the study authors wrote, "These results speak to a social decision-making process between the patient and provider -- a partnership that involves sequential interactions whereby both the patient and provider may influence the other's evaluation of the patient's readiness for treatment, with treatment initiation dependent on both agreeing on the need for treatment and the patient's readiness for treatment."

RAND Corporation, Santa Monica, CA; AIDS Healthcare Foundation, Los Angeles, CA; Greater Los Angeles Veterans Administration, Los Angeles, CA; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA.

12/15/09

Reference

KC Osilla, G Ryan, L Bhatti, and others. Factors that influence an HIV coinfected patient's decision to start hepatitis C treatment (Abstract). AIDS Patient Care STDS. November 22, 2009 [Epub ahead of print].