? About 4 million Americans, and 170 million persons worldwide are infected with the Hepatitis C virus (HCV). Each year, 8,000-10,000 Americans die of HCV. End stage liver disease due to HCV is one of the leading cause for liver transplantation in the United States. Co-infection with HCV and human immunodeficiency virus (HIV) is common with over one-third of the HIV infected patients in the US being co-infected with HCV. Despite high prevalence and mortality, very few patients with HCV and even fewer with HCV-HIV co-infection receive treatment for HCV. Additionally, the long term outcomes after HCV treatment in HCV-HIV co-infected patients are unknown. The goal of this application is to study the treatment patterns of HCV in patients with and without HIV co-infection, and the clinical outcomes after treatment and to prepare the applicant for an independent research career in the field of HCV-HIV co-infection. The specific research aims are to determine i) whether HCV-HIV co-infected patients are less likely to receive treatment for HCV than those infected with HCV alone, and whether this disparity could be explained by HIV co-infection itself, age, race, gender, history of psychiatric illness, and drug and alcohol use ii) whether HCV-HIV infected patients who do receive treatment for HCV are less likely to complete the course of treatment when compared with HCV alone infected patients, and to understand the factors associated with failure to complete treatment, and iii) whether patients who complete the treatment have improved outcomes as measured by survival, emergency department visits, liver disease related hospitalization and incidence of hepatocellular carcinoma. The study population will be all HCV infected Veterans who have been entered in the national VA administrative database between 1999 and 2002. The total number of patients newly diagnosed to be HCV antibody positive in the VA Healthcare System during 1999-2001 was 109,700. Demographic and social variables, prescription and completion of HCV treatment, clinical outcomes including survival, liver disease related hospitalizations, utilization of emergency care for liver disease related conditions and development of hepatocellular carcinoma will be studied. This information will be retrieved from the national VA administrative database using ICD 9 codes, and from the Pharmacy Benefits Management database. To attain the educational goals of this application, the applicant will enroll in University of Pittsburgh Clinical Research Training Program, to complete course work for a Masters of Science degree in Clinical Effectiveness and Outcomes Research, and participate actively in the School of Medicine's continuing educational activities. The long term objective of the applicant is to make a clinically relevant impact on the HCV treatment patterns and outcomes, especially in the HCV-HIV co-infected patients. ? ? ? ?
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