(WITHDRAWN) Time to HCV Treatment Disfavors HIV Patients Living with HCV Co-Infection

Background and Aims: Evaluation for HCV treatment is not as complex with new direct acting antivirals (DAAs) as it has been with prior non-DAA regimens. This study aimed to identify predictors of longer time to HCV treatment intervals (i.e. the time between initial clinical evaluation for HCV and the HCV treatment start date) among a clinic sample of patients living with HCV mono-infection and HIV/HCV co-infection.

Method: Patients with HCV who received DAA treatment (n=214) at a university affiliated clinic between January 2013 and July 2017 were included in the study. Binomial logistic regression was used to identify independent predictors of longer time to treatment intervals.

Results: The majority of patients were insured (82%) and genotype 1 (81%). Nearly a third had a psychiatric disorder (32%), and 25% and 13% had substance and alcohol use disorders, respectively. All patients with HIV/HCV co-infection were stably on antiretroviral therapy (ART) prior to HCV evaluation for DAA treatment. Ledipasvir-sofosbvir was the most commonly prescribed DAA regimen. Compared to patients who were treated <6 months from HCV evaluation for DAA treatment, patients who were treated >6 months were older (56±11.3 vs. 57±8.7) and a higher proportion had HIV/HCV co-infection (31% vs. 49%, p=0.007) and chronic kidney disease (CDK) (8% vs. 18%, p=0.030). Patients who were treated <6 months and >6 months from HCV evaluation for DAA treatment did not differ in other clinical characteristics. In multivariate analysis, after adjusting for age, gender, race, insurance status, psychiatric, alcohol, and substance use disorders, and chronic kidney disease, HIV/HCV co-infection was positively associated with longer time to treatment intervals (OR=2.031, CI:1.060 – 3.894).

Discussion: HIV/HCV co-infection was an independent predictor of longer time to HCV treatment intervals—the odds of longer time to treatment intervals was 2 times higher for patients with HIV/HCV co-infection. Potential barriers that may delay time to DAA treatment, psychiatric and alcohol and substance use disorders and CKD, did not negatively impact time to DAA treatment; and patients with HIV/HCV co-infection were stably on ART. Findings highlight a need for social workers to examine and ascertain the reasons why time to DAA treatment disfavors patients with HIV/HCV co-infection—who are receiving services and care from the same clinic and providers as patients with HCV mono-infection.