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In addition, researchers observed that physicians typically recommend HCV treatment for patients with moderate liver disease and defer it for those with minimal disease progression.
“Given the more rapid disease progression among co-infected patients and the greater likelihood of treatment success with milder disease,” they suggest physicians reconsider decisions to delay treatment.
“We need to identify all cases of HCV, so we can start treatment when it is most effective. As co-infected patients are particularly prone to cirrhosis and end-stage liver disease, we need to catch them early, when they can still be treated and see an improvement in overall health,” Czarnogorski said.
According to the study, African-American and Hispanic patients received recommendations for treatment less often than their Caucasian counterparts, even though they accounted for the majority of study participants. The discrepancy may be indicative of broader health care disparities, noted the authors, but it also might be reflective of the lower response rates to the traditional two-drug treatment for HCV among these populations.
Physician characteristics also factored into recommendations for treatment: Physicians who saw fewer patients on a weekly basis and those with more years at the site were more likely to recommend HCV therapy to patients, perhaps reflecting their greater confidence in having the time and skills to manage the often complex treatment. Female physicians and those with lower thresholds for gauging patient readiness, which may be a proxy for the urgency assigned to treatment by the physician, also recommended treatment more often.
The researchers noted that the new triple therapy for HCV, which includes protease inhibitors, may affect treatment recommendations.
While still being studied for HIV positive patients, Czarnogorski said she expects the triple therapy will be approved for co-infected individuals. The increased efficacy of the treatment, though, will need to be balanced against the potential for drug-drug interactions between the protease inhibitors and highly active antiretroviral therapy (HAART) medications used to treat HIV. In addition, the increased complexity of the regime may make physicians more cautious about recommending it.
1. Wagner G, Chan Osilla K, Garnett J, et al. Provider and Patient Correlates of Provider Decisions to Recommend HCV Treatment to HIV Co-infected Patients. J Int Assoc Physicians AIDS Care. 2012;11(4):245-251.
2. Monga HK, Rodriguez-Barradas MC, Breaux K, Khattak K, Troisi CL, Velez M, Yoffe B. Hepatitis C Virus Infection-Related Morbidity and Mortality among Patinets with Human Immunodeficiency Virus Infection. Clin Infect Dis. (2001)33(2):240-247. http://cid.oxfordjournals.org/content/33/2/240.full
3. Management and Treatment of Hepatitis C Virus Infection in HIV-Infected Adults. Sept 1, 2005. http://www.hepatitis.va.gov/provider/guidelines/hiv-coinfection.asp#S1X
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