Journal of General Internal Medicine

, Volume 19, Issue 4, pp 357–365 | Cite as

Hepatitis C virus infection in san francisco’s HIV-infected urban poor

High prevalence but low treatment rates
  • Christopher S. Hall
  • Edwin D. Charlebois
  • Judith A. Hahn
  • Andrew R. Moss
  • David R. Bangsberg
Populations At Risk

Abstract

OBJECTIVE: To measure Hepatitis C Virus (HCV) prevalence, incidence, and initiation of HCV therapy in a representative HIV-infected cohort of the urban poor.

DESIGN: Cohort analysis.

SETTING: The Research and Access to Care for the Homeless (REACH) Cohort is a systematic sample of HIV-infected marginally housed individuals identified from single-room occupancy hotels, homeless shelters, and free lunch programs in San Francisco.

PARTICIPANTS: Two hundred forty-nine participants with 28.9 months (median) of follow-up were studied. Mean age was 44 (range 24 to 75, standard deviation ±8.4) years. Eighty-two percent were male, 43% were African-American, 64% were lifetime injection drug users, and 24% had been on the street or in a shelter in the prior month.

INTERVENTIONS: We measured HCV testing and treatment history with structured interviews; additionally, participants were tested for HCV antibodies (EIA-2) with RNA viral load confirmation.

MAIN RESULTS: At baseline, 172 (69.1%) were HCV-positive and 182 (73.1%) were HCV-positive at follow-up, including 155 (62.2%) with viremia. HCV-positive status was associated with having injected drugs, elevated serum alanine aminotransferase, homelessness in the last 1 year, and more severe depressive symptoms. The incidence of new HCV infection was 4.63% per person-year (ppy; 95% confidence interval, 2.31 to 8.13) in the entire cohort and 16.77% ppy among injection drug users. The prevalence of HCV antibody-negative HCV-viremia was 13.2% (10/76). Nonwhites were less likely to receive HCV testing and subspecialty referral, controlled for drug use and other confounders. Sixty-eight percent (123/182) were aware treatment was available; however, only 3.8% (7/182) or 1.16% ppy received HCV treatment.

CONCLUSIONS: While HCV infection is common, HCV treatment is rare in the HIV-HCV coinfected urban poor. Urban poor, nonwhite individuals are less likely to receive HCV testing and subspecialty referral than their white counterparts. Antibody-negative infection may complicate screening and diagnosis in HIV-infected persons.

Key words

hepatitis C HIV infection HIV/HCV coinfection HCV treatment homelessness 

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Copyright information

© Society of General Internal Medicine 2004

Authors and Affiliations

  • Christopher S. Hall
    • 1
  • Edwin D. Charlebois
    • 1
  • Judith A. Hahn
    • 2
  • Andrew R. Moss
    • 2
  • David R. Bangsberg
    • 1
    • 3
  1. 1.the Epidemiology and Prevention Interventions CenterDivision of Infectious Diseases, San Francisco General HospitalUSA
  2. 2.Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan Francisco
  3. 3.the San Francisco General Hospital AIDS ProgramUniversity of CaliforniaSan Francisco
  4. 4.Epidemiology and Prevention Interventions CenterUniversity of CaliforniaSan Francisco

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