Background:  Rate and predictors of treatment for hepatitis C virus (HCV) are unknown.

Methods:  Using ICD-9 codes, we assembled a national cohort of HCV-infected subjects from the Department of Veterans Affairs (VA) National Patient Care Database (NPCD). All veterans seen in the VA Healthcare system between fiscal years 1999 and 2003 were included. Prescription for HCV was obtained from the Pharmacy Benefits Management database, and was defined as having received interferon-alfa, pegylated interferon-alfa, or a combination of either with ribavirin for any duration of time. Diagnoses of comorbid medical and psychiatric conditions and drug and alcohol use were also obtained using ICD-9 codes. Utility of ICD-9 codes has been previously validated by our group and others.

Results:  We identified 120,507 subjects with HCV infection, of whom 6502 were co-infected with HIV. The HCV/HIV-co-infected subjects were younger, more likely to be black and male. The HCV/HIV-co-infected subjects were less frequently diagnosed with coronary artery disease, peripheral vascular disease, hypertension, diabetes, cirrhosis, and post-traumatic stress disorder, but more frequently diagnosed with anemia, hepatitis B, major depression, mild depression, schizophrenia, alcohol use, and drug use. HCV/HIV co-infected were less likely to have been prescribed treatment for HCV (7.2% vs 11.8%, p <0.0001) (Table 1). In multivariable logistic regression analysis, the following were predictors of non-treatment for HCV/HIV co-infection (OR 0.74, 95%CI 0.67 to 0.82); increasing age; black race; Hispanic race; drug use; anemia; bipolar disorder; major depression; and mild depression (Table 2).

Conclusions:  While we did not ascertain the indications and contraindications for treatment, subjects with HIV co-infection were treated less frequently for HCV. Non-treatment was associated with increasing age, minority race, diagnoses of drug use, anemia, and depression.