HCV New Drugs

By Michael Smith, North American Correspondent, MedPage Today

 

Published: October 22, 2012

 

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco

 

SAN DIEGO – Hospital admission rates for people with hepatitis C have risen nearly five-fold over a 15-year period, a researcher said here.

Over the same period, hospital discharge records show, admissions for people with HIV have been cut nearly in half, according to Christine Oramasionwu, PharmD, PhD, of the University of North Carolina in Chapel Hill, N.C.

But surprisingly, admission rates for people with both infections were in the middle – rising by a factor of slightly more than 2, Oramasionwu told an oral session at the annual IDWeek meeting here.

Advances in therapy for both infections have changed markedly over the period from 1996 through 2010, Oramasionwu said, but there has been little study of the differential burden of the two on the healthcare system.

To help clarify the issue, she and colleagues used the annual National Hospital Discharge Surveys to analyze rates of hospital admission and mortality from HIV, hepatitis C, and both combined.
Over the study period, there were an estimated 6.6 million hospital discharges coded for one or both of the infections – 39% were for HIV, 56% for hepatitis C, and 5% for co-infection.

From 1996 through 2010, Oramasionwu said, the rate of admission for HIV fell from 9.9 per 100,000 people to 5.3, while the rate for hepatitis C rose from 2.2 per 100,000 to 10.5.

The admission rate for people with co-infections rose from 0.3 per 100,000 to 0.7, she reported.
Mortality rates for all three fell, but the decline in mortality for hepatitis C was the "least pronounced," she said.

The surprise was the small effect of co-infection, Oramasionwu said. "We actually expected that the co-infected population would have higher levels of healthcare utilization," she said.

Several comorbidities were significantly different among the three groups, she said: ,
;

• Hepatitis B infection was seen in 2% of those with HIV, 5% of those with hepatitis C, and 10% of those with co-infections.
• Injection drug use was seen in 15% of the HIV group, 17% of the hepatitis C group, and 24% of the co-infection population.
• Alcohol use was observed in 9% of the HIV group, 19% of the hepatitis C group, and 13% of the co-infected.
• All the differences were significant at P<0.001.

She cautioned that the study was retrospective and observational and that the researchers did not have access to laboratory markers of the severity of disease.

"I was surprised to see that the hepatitis C rates were higher than the co-infected rates," commented Demetre Daskalakis, MD, of the New York University School of Medicine in New York City, who was not involved in the study but who moderated the session at which it was presented.

"I think it's a testimony to the effect of highly active retroviral therapy," he said, which would help keep co-infected patients in better health, despite their hepatitis.

Daskalakis added that the quality of care for people with HIV may also play a role, although he cautioned there's no way to support that idea from the data so far.

"I think it has to do with the fact that they're seen a lot ... in the primary HIV care model that many of those people live under," he told MedPage Today.

As well, people with HIV may find it easier to access various forms of care, under such programs as the Ryan White Care Act, he noted.

"There's really nothing like that for hepatitis C," he said.