RESUMO
The last international consensus conference about hepatitis C virus (HCV) treatment emphasized the importance of treatment for persons coinfected with HCV and human immunodeficiency virus (HIV). As liver biopsy precedes treatment, we aimed to identify factors associated with the performance of liver biopsy among HIV-HCV coinfected drug users during a 5-year follow-up to study their access to HCV treatment. Of the 296 patients followed in the HIV hospital departments of Nice and Marseilles and with retrievable records about HCV diagnosis and care, 166 were eligible for analysis having had detectable HCV RNA at least once during the study period. Overall, 45.2% of patients underwent liver biopsy during follow-up. Using proportional hazard models, predictors of having had a liver biopsy were high social support, complete abstinence from drug injection, and lack of immunosuppression as well as male gender, no history of multiple incarcerations, more recent onset of drug use, and an increase of liver enzyme levels. These results suggest that specific efforts should be devoted to HIV-HCV coinfected drug users to assist with stabilizing these patients to optimize their access to HCV care whenever possible.
Assuntos
Biópsia/estatística & dados numéricos , Infecções por HIV/patologia , Hepatite C/patologia , Fígado/patologia , Alanina Transaminase/análise , Antirretrovirais/uso terapêutico , Aspartato Aminotransferases/análise , Feminino , França , Fidelidade a Diretrizes , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Acessibilidade aos Serviços de Saúde , Hepacivirus/enzimologia , Hepacivirus/genética , Hepatite C/complicações , Hepatite C/terapia , Departamentos Hospitalares , Humanos , Técnicas Imunoenzimáticas/estatística & dados numéricos , Fígado/enzimologia , Estudos Longitudinais , Masculino , Modelos de Riscos Proporcionais , Fatores Sexuais , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/virologiaRESUMO
Self-reported adherence and plasma protease inhibitor concentration (PPIC) were assessed in 642 HIV-infected patients at month 4 of a single protease inhibitor-containing regimen. PPIC was below the limit of quantification (LOQ) in 32% of non-adherent patients and in 8% of adherent patients. The relationship between non-adherence and a detectable HIV viral load was enhanced when adherent patients with PPIC below LOQ were considered to be non-adherent. PPIC combined with self-report may more reliably detect non-adherence.
