While attending the memorial of a coinfected patient who had died from end-stage liver disease, a colleague asked me why I wasn’t treating my coinfected patients for hepatitis C. Referring them to a gastroenterologist wasn’t working. I was concerned about treating patients with psychiatric comorbidities and/or ongoing substance use. My colleague encouraged me to figure out how, rather than whether, to deliver care to these patients . . . or we would continue to attend funerals of patients dying prematurely from complications of hepatitis C. Since then, my role has changed from gloom and doom—warning patients about side effects—to one of providing education and support and encouraging patients to try HCV treatment.1 —Lynn E. Taylor, MD Miriam Hospital, Providence, RI

Introduction

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Prevalence of the hepatitis C virus (HCV) may be as high as 30 percent among people living with HIV/AIDS (PLWHA) and as high as 90 percent among PLWHA who contracted HIV infection through injection drug use (IDU). End-stage liver disease associated with HCV is now a major cause of death among PLWHA.2-4

Today, the standard of care is for all PLWHA to be screened for HCV and for all coinfected patients to receive comprehensive care services. Evidence suggests that this is not happening—and for many reasons.

The purpose of this publication is to help Ryan White Comprehensive AIDS Resources Emergency (CARE) Act planners, administrators, and providers address those reasons, deal with barriers to care faced by those in need, and construct a response to HIV/HCV coinfection that reflects the current standard of care.

This guide comes at a time of intense pressure on the HIV care system arising from such factors as rising health care costs and growing HIV prevalence among the poor and uninsured. It reflects that providers must cope with these difficult issues. But this publication also is full of optimism, reflecting that providers of HIV/AIDS services already have much of the capacity necessary for providing some services required by coinfected people—and that the financial barriers to ensuring access to comprehensive care that includes HCV treatment may not be as significant as may first appear.

Nonetheless, navigating the road that leads to a better system of care for coinfected patients requires commitment—the same kind of commitment that providers have shown throughout 25 years of HIV/AIDS. In this publication, the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA) urges organizations to make that commitment and provides a framework for ensuring that comprehensive services are extended to all HIV/HCV-coinfected patients.