Timing of treatment initiation of direct-acting antivirals for HIV/HCV coinfected and HCV monoinfected patients

ABSTRACT

Direct-acting antiviral therapy is safe and cost-effective for the treatment of hepatitis C virus (HCV) infection. However, variability in drug payment rules represents a barrier to treatment that may disproportionately affect certain populations. We conducted a retrospective cohort study among HIV/HCV coinfected and HCV monoinfected patients using Kaplan–Meier and Fisher’s exact test to analyze the time from the prescription of a direct-acting antiviral agent to delivery to the patient. Variables with significance p < .20 in univariate analysis were included in a Cox regression model. Factors associated with faster treatment were Infectious Diseases office setting (p = .01), public insurance payer (p = .01), and initial approval of requested regimen (p = .01). The presence of other liver disease was associated with delay in treatment (p = .05). Unrestrictive Medicare and Medicaid regulations resulted in more rapid delivery of medication compared to private payers. Fibrosis level, Child–Pugh class and HIV status did not significantly change time to treatment.

KEYWORDS:

• HIV/HCV coinfected
• direct-acting antivirals
• barriers to care
• HCV therapy
• time to treatment

Disclosure statement

No potential conflict of interest was reported by the authors.