HCV/HIV/coinfection among veterans presents challenges for caregivers

April 16, 2013 – The DCRI’s Susanna Naggie, MD, presented her research at the 2013 Conference on Retroviruses and Opportunistic Infections in Atlanta last month.

Military veterans with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections carry a significant health care burden, according to a study by the DCRI’s Susanna Naggie, MD, and Andrew Muir, MD, MHS, and researchers from Duke and the Durham VA Medical Center.

The study, “Trends and Patterns of Healthcare Utilization among Hepatitis C Virus, HIV, and HIV/Hepatitis C Virus Co-infected Veterans: Understanding the Burden of Disease,” was presented in a poster session at the 2013 Conference on Retroviruses and Opportunistic Infections, held last month in Atlanta.

The U.S. Department of Veterans Affairs (VA) is the single largest provider of care for HCV patients in the country. Among veterans with HIV, approximately 30 percent also have HCV. Coinfected patients are at a significantly increased risk of death, liver disease progression, and other complications, which creates a significant challenge for the clinicians responsible for their care. Coinfected patients also utilize health care services more frequently than patients infected with HCV or HIV alone, but until now the reasons behind this and the ways in which they use these services have not been examined.

To better understand how coinfected patients engage health care services, Naggie, Muir, and their colleagues compared rates of health care utilization and reasons for hospital admission among HCV-infected, HIV-infected, and HCV/HIV-coinfected patients. To do so, they examined patient data collected by the VA between 1998 and 2010. Their data set included information on demographics, annual numbers of hospitalizations, annual clinic visits, and reasons for hospitalization.

The researchers found that more than 345,000 veterans were infected with HCV and more than 60,000 were infected with HIV. A total of 14,144 veterans were identified as HCV/HIV coinfected. All three cohorts (HCV, HIV, and coinfected) were predominantly male (97.1 percent) and similar in median age (58.7, 57.6, and 57.1 years, respectively). Veterans with HCV were more likely to be white (63.2 percent), whereas coinfected veterans were more likely to be black (61.1 percent).

The data also revealed that annual rates of emergency department and outpatient clinic visits have been steadily climbing for all cohorts, while rates of hospital admission have stayed relatively constant. The primary discharge diagnoses for hospital admission, in all cohorts, were psychiatric, cardiovascular disease, trauma, gastrointestinal, and non-AIDS infection. HCV/HIV-coinfected patients had higher rates of utilization than either HCV- or HIV-mono-infected patients.

The researchers concluded that HCV-infected veterans, particularly those with HCV/HIV coinfection, are increasingly in need of health care services across a wide range of comorbidities. Health care systems and caregivers should focus on providing these services, with an emphasis on psychiatric and cardiovascular issues.