Despite the high prevalence of hepatitis C virus (HCV) infection among injection drug users also infected with human immunodeficiency virus (HIV), and the synergistic adverse effect of the two diseases on patients’ health and survival, research on the clinical management of these patients and particularly the low uptake of HCV therapy is limited. We conducted qualitative interviews with 17 HIV providers from two urban public hospitals. We discovered that the limitations of the current state of medical knowledge, the severe side effects of HIV and HCV therapies, and the psychosocial vulnerability of HIV/HCV-coinfected patients combined with their resistance to becoming informed about HCV posed significant challenges for providers. To contend with these challenges, providers incorporated key dimensions of patient-centered medicine in their practice, such as considering their patients’ psychosocial profiles and the meaning patients assign to being coinfected, and finding ways to engage their patients in a therapeutic alliance.
AdeyemiO. M.JensenD.AttarB.GhaouiR.GallagherM.WolenD.CotlerS. J. (2004). Hepatitis C treatment eligibility in an urban population with and without HIV coinfection. AIDS Patient Care and STDs, 18, 239-245. doi:10.1089/10872910432303891910.1089/108729104323038919.
2.
BalintE. (1969). The possibilities of patient-centered medicine. Journal of the Royal College of General Practitioners, 17, 269-276.
3.
BovaC.OgawaL. F.Sullivan-BolyaiS. (2010). Hepatitis C treatment experiences and decision making among patients living with HIV infection. Journal of the Association of Nurses in AIDS Care, 21, 63-74. doi:10.1016/j.jana.2009.07./00910.1016/j.jana.2009.07./009
4.
Centers for Disease Control and Prevention. (2004). Treating opportunistic infections among HIV-infected adults and adolescents: Recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association/Infectious Diseases Society of America. Morbidity and Mortality Weekly Report, 53(No. RR-15), 51-53. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5315a1.htm
5.
ClanonK. A.MuellerJ. J.HarankM. (2005). Integrating treatment for hepatitis C virus infection into an HIV clinic. Clinical Infectious Diseases, 40, S362-S366. doi:10.1086/42745410.1086/427454
6.
CorcoranC. P. (2003). Neuropsychiatric changes in HIV/hepatitis C coinfected patients undergoing interferon therapy. Journal of the Association of Nurses in AIDS Care, 14, 80S-86S. doi:10.1177/105532900325558910.1177/1055329003255589
7.
DoreG. J.ThomasD. L. (2005). Management and treatment of injection drug users with hepatitis C virus (HCV) infection and HCV/human immunodeficiency virus coinfection. Seminars in Liver Disease, 25, 18-32. doi:10.1055/s-2005-86477910.1055/s-2005-864779
8.
FlemingC. A.TumiltyS.MurrayJ. E.NunesD. (2005). Challenges in the treatment of patients coinfected with HIV and hepatitis C virus: Need for team care. Clinical Infectious Diseases, 40, S349-S354. doi:10.1086/42745210.1086/427452
9.
FullerB. E.LoftisJ. M.RodriguezV. L.McQuestenM. J.HauserP. (2009). Psychiatric and substance use disorders comorbidities in veterans with hepatitis C virus and HIV coinfection. Current Opinion in Psychiatry, 22, 401-408. doi:10.1097/YCO.0b013e32832cadb910.1097/YCO.0b013e32832cadb9
10.
FultzS. L.JusticeA. C.ButtA. A.RabeneckL.WeissmanS.Rodriguez-BarradasM. (2003). Testing, referral, and treatment patterns for hepatitis C virus coinfection in a cohort of veterans with human immunodeficiency virus infection. Clinical Infectious Diseases, 36, 1039-1046. doi:10.1086/37404910.1086/374049
11.
GrebelyJ.GenowayK. A.RaffaJ. D.DhadwalG.RajanT.ShowlerG.FischerB. (2008). Barriers associated with the treatment of hepatitis C virus infection among illicit drug users. Drug and Alcohol Dependence, 93, 141-147. doi:10.1016/j.drugalcdep.2007.09.00810.1016/j.drugalcdep.2007.09.008
12.
KeirnsC. C.Dorr GooldS. (2009). Patient-centered care and preference-sensitive decision making. JAMA, 302, 1805-1806. doi:10.1001/jama.2009.155010.1001/jama.2009.1550
13.
LaineC.DavidoffF. (1996). Patient-centered medicine: A professional evolution. JAMA, 275, 152-156. doi:10.1001/jama.1996.0353026006603510.1001/jama.1996.03530260066035
14.
MarcellinF.PreauM.DellamonicaP.RavauxI.KurkdjiP.ProtopoescuC.SpireB. (2007). Adding HCV treatment to HIV treatment in HIV-HCV coinfected patients: The impact on the different dimensions of fatigue and self-reported side effects. Journal of Pain and Symptom Management, 34, 413-421. doi:10.1016/j.jpainsymman.2006.12.01410.1016/j.jpainsymman.2006.12.014
15.
MeadN.BowerP. (2000). Patient-centredness: A conceptual framework and review of the empirical literature. Social Science and Medicine, 51, 1087-1110. doi:10.1016/S0277-9536(00)00098-810.1016/S0277-9536(00)00098-8
16.
MehtaS. H.GenbergB. L.AstemborskiJ.KavaseryR.KirkG. D.VlahovD.ThomasD. L. (2008). Limited uptake of hepatitis C treatment among injection drug users. Journal of Community Health, 33, 126-133. doi:10.1007/s10900-007-9083-310.1007/s10900-007-9083-3
17.
MehtaS. H.ThomasD. L.SulkowskiM. S.SafaeinM.VlahovD.StrathdeeS. A. (2005). A framework for understanding factors that affect access and utilization of treatment for hepatitis C virus infection among HCV-mono-infected and HIV/HCV-co-infected injection drug users. AIDS, 19(Suppl. 3), S179-S189.
18.
MorseJ. M. (2009). The PI as participant. Qualitative Health Research, 19, 1655. doi:10.1177/104973230935342110.1177/1049732309353421
19.
MuhrT. (1997). ATLAS.ti: The knowledge workbench short user’s manual. Berlin: Scientific Software Development.
20.
NunesD.SaitzR.LibmanH.ChengD. M.VidaverJ.SametJ. H. (2006). Barriers to treatment of hepatitis C in HIV/HCV-coinfected adults with alcohol problems. Alcohol Clinical Experimental Research, 30, 1520-1526. doi:10.1111/j.1530-0277.2006.00183.x10.1111/j.1530-0277.2006.00183.x
21.
SilberbogenA. K.UlloaE. W.JankeE. A.MoriD. L. (2009). Psychosocial issues and mental health treatment recommendations for patients with hepatitis C. Psychosomatics, 50, 114-122. doi:10.1176/appi.psy.50.2.11410.1176/appi.psy.50.2.114
22.
SorianoV.PuotiM.SulkowskiM.CargnelA.BenhamouY.PetersM.RockstrohJ. (2007). Care of patients coinfected with HIV and hepatitis C virus: 2007 updated recommendations from the HCV-HIV international panel. AIDS, 21, 1073-1089. doi:10.1097/QAD.0b013e3281084e4d10.1097/QAD.0b013e3281084e4d
23.
StewartM.BrownJ. B.WestonW., W.McWhinneyI. R.McWilliamC. L.FreemanT. R. (2003). Patient-centered medicine: Transforming the clinical method (2nd ed.). Abingdon, UK: Radcliffe Medical Press.
24.
StraderD. B.WrightT.ThomasD. L.SeeffL. B. (2004). Diagnosis, management, and treatment of hepatitis C. Hepatology, 39, 1147-1171. doi:10.1002/hep.2011910.1002/hep.20119
25.
SulkowskiM. (2008a). Treatment of hepatitis C in HIV-infected persons: A work in progress. Journal of Hepatology, 48, 5-7. doi:10.1016/j.jhep.2007.10.00610.1016/j.jhep.2007.10.006
26.
SulkowskiM. S. (2008b). Viral hepatitis and HIV coinfection. Journal of Hepatology, 48, 353-367. doi:10.1016/j.jhep.2007.11.00910.1016/j.jhep.2007.11.009
27.
ThompsonV. V.RaglandK. E.HallC. S.MorganM.BangsbergD. R. (2005). Provider assessment of eligibility for hepatitis C treatment in HIV-infected homeless and marginally housed persons. AIDS, 19(Suppl. 3), S208-S214.
28.
WagnerG.RyanG.OsillaK. C.BhattiL.GoetzM.WittM. (2009). Treat early or wait and monitor? A qualitative analysis of provider hepatitis C virus treatment decision-making in the context of HIV coinfection. AIDS Patient Care and STDs, 21, 715-725. doi:10.1089/apc.2009.004910.1089/apc.2009.0049
29.
WagnerG. J.RyanG. W. (2005). Hepatitis C virus treatment decision-making in the context of HIV co-infection: The role of medical, behavioral and mental health factors in assessing treatment readiness. AIDS, 19(Suppl. 3), S190-S198.
30.
WeissJ. J.GormanJ. M. (2006). Psychiatric behavioral aspects of comanagement of hepatitis C virus and HIV. Current HIV/AIDS Reports, 3, 176-181. doi:10.1007/s11904-006-0013-210.1007/s11904-006-0013-2
31.
WeissJ. J.MorgelloS. (2009). Psychiatric management of HIV/HCV-coinfected patients beginning treatment for hepatitis C virus infection: Survey of provider practices. General Hospital Psychiatry, 3, 531-537. doi:10.1016/j.genhosppsych.2009.05.00610.1016/j.genhosppsych.2009.05.006
