HIV/HCV Coinfections: Barriers to Effective Treatment

heptocellular carcinoma in the liver
heptocellular carcinoma in the liver
Only a small percentage of people with HIV/HCV coinfection receive treatment for hepatitis C.
This article is part of Infectious Disease Advisor’s coverage of IDWeek 2017™, which took place in San Diego, CA. Our staff will be reporting on the latest breaking research and clinical advances in infectious diseases. Check back regularly for highlights from IDWeek 2017.

People with HIV and hepatitis C virus (HCV) coinfection have a worse prognosis than people with HIV alone despite the efficacy of oral direct-acting antiviral therapy in treating coinfections, according to research presented at IDWeek 2017, held in San Diego, California.

Researchers conducted a retrospective observational study of patients with HIV and HCV coinfection (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).

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“Only one half of the coinfected 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.