Challenges of caring for HIV/HCV coinfected patients: The health care provider's perspective

APHA Scientific Session and Event Listing

Helen-Maria Lekas, PhD¹, Karolynn Siegel, PhD¹, and Jason Leider, MD; PhD². (1) Center for the Psychosocial Study of Health & Illness, Columbia University, 100 Haven Avenue, Suite 6A, New York, NY 10032, 212-304-6488, HL11@columbia.edu, (2) Director of Adult HIV Services, Albert Einstein College of Medicine, NBHN, Jacobi Medical Center, 1400 Pelham Parkway So., 6A-01 JACP, Bronx, NY 10461

Background: Chronic infection with the hepatitis C virus (HCV) is a prevalent comorbidity afflicting persons with HIV/AIDS. The poorly understood synergy between HIV and HCV disease, the hepatotoxicity of HIV therapies and limited efficacy of HCV therapies complicates the management of HIV/HCV coinfected patients. Methods: To understand how health care providers cope with the challenges of managing coinfected patients, a content analysis of in-depth interviews with 17 providers (10 MDs and 7 NPs) from two NYC HIV clinics was conducted. Results: Providers revealed that they: 1) viewed the existence of several HIV comorbidities (including HCV, diabetes, heart disease) as a characteristic of the current phase of the AIDS epidemic, the primary cause of mortality, and a significant clinical challenge; 2) managed the uncertainty surrounding HCV therapies and the hepatotoxicity of HIV therapies, by relying upon their experience with the highly toxic and new HIV therapies; 3) based their HIV/HCV treatment decisions primarily on their own experience treating HIV, informal consultations with colleagues and scrutiny of formal information sources (e.g., guidelines, consensus conferences, research literature); and 4) struggled to meet their patients' psychological, drug-treatment and social services needs, allay their chronic distrust of medical authority and engage them in their own care. Conclusion: Providers relied upon their knowledge, competence and experience in the HIV field for the management of their coinfected patients who tend to have complex medical and psychosocial profiles. They suggested that effective clinical management of these patients presupposes the provision of mental health, drug treatment and social services.

Learning Objectives:

At the conclusion of the session, the participant (learner) in this session will be able to

1) Identify the clinical challenges facing health care providers who care for HIV/HCV coinfected patients.
2) Evaluate the strategies health care providers employ to manage the uncertainty characterizing the treatment of HIV/HCV coinfected patients and to design and implement treatment plans for this patient population.
3) Recognize the impact of coinfected patients’ psychosocial needs on their clinical management.
4) Define the mental health, drug-treatment and social service resources necessary for the comprehensive care of coinfected patients.
5) Develop an integrated care plan for coinfected patients.

Keywords: Hepatitis C, Treatment

Presenting author's disclosure statement:

Not Answered

HIV/AIDS Issues among Focused Populations

The 134th Annual Meeting & Exposition (November 4-8, 2006) of APHA