HIV/HCV Co-Infections: Barriers to Effective Treatment
People with HIV/HCV co-infection have a worse prognosis than people with mono-infection.
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People with HIV and hepatitis C virus (HCV) co-infection have a worse prognosis than people with HIV alone despite the efficacy of oral direct-acting antiviral therapy in treating co-infections, according to research presented at IDWeek 2017, held in San Diego, California.
Researchers conducted a retrospective observational study of patients with HIV and HCV co-infection (n=115; median age: 54; 67.8% African-American). Patients had median CD4 counts of 515 (interquartile range [IQR]: 354-750), with controlled viremia (viral load <200 copies) and fibrosis scores >F3 (44.3%). Of patients with HIV/HCV co-infection, 60 were treated for HCV; the remaining 55 untreated patients were in the process of being evaluated, actively using illicit substances (20% and 16.4%, respectively), or had uncontrolled HIV viremia (viral load >200 copies).
The investigators found that HCV-treated patients more commonly had an undetectable viral load, CD4 count >200, and the absence of cocaine abuse (60% vs 40%, 58% vs 42%, and 58% vs 42%, respectively). Patients who completed treatment for HCV had higher rates of screening for hepatocellular carcinoma (62% vs 33%; P =.005).
“Only one half of the co-infected patients were treated for HCV,” the researchers noted. To best help patients overcome treatment barriers, clinicians should provide resources and support to encourage cessation of cocaine use and encourage frequent follow-up visits to achieve HIV suppression. “This will improve access to treatment, decrease mortality, and improve the quality of life for this patient group,” the researchers concluded.
Disclosures: Drs Chou and Lee are grant investigators at and have received research grants from Gilead.
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Deering C, Coppock D, Boyle S, et al. Barriers to hepatitis C treatment in HIV co-infected patients in the era of new direct-acting antiviral therapy. Presented at: IDWeek 2017; October 4-8, 2017; San Diego, CA. Abstract 2233.