2 Barriers to Effective Treatment of HIV/HCV Co-Infected Patients

Physicians looking to provide effective treatment to co-infected patients mustn't overlook uncontrolled viremia or substance abuse, according to a new study.

A new study has identified 2 significant barriers to effective Hepatitis C (HCV) infection treatment that limit successful outcomes for patients co-infected with HCV and Human Immunodeficiency Virus (HIV).

Uncontrolled HIV viremia and substance abuse often delay or halt HCV treatment altogether, according to study author Caytlin Deering, DO, of Drexel University College of Medicine in Philadelphia, PA, and colleagues, who presented the study’s results at ID Week 2017 in San Diego, CA.

“To overcome these barriers, we suggest: (1) providing support and resources to help patients cease cocaine use, (2) encourage frequent follow up with patients to achieve HIV suppression,” the authors wrote.

Researchers began with the understanding that HCV disproportionately affects HIV-infected patients, and that co-infected patients have worse prognoses than mono-infected patients. HCV treatment with new oral direct acting antiviral (DAA) therapy is known to be effective in HIV/HCV co-infected patients with cure rates similar to mono-infected patients, but despite effective treatments, only a small proportion of co-infected patients are treated for HCV infection.

Researchers performed a retrospective observational study of HIV/HCV co-infected patients seen at an urban HIV clinic at Drexel University in 2016, and compared patients who were treated for HCV infection versus those who were untreated.

Among 1322 patients seen, 112 patients had chronic HCV infection. The median age was 54 (IQR: 48-58) years old, and 68% were African American. Median CD4 counts were 515 (534-750), 85% had controlled viremia (VL <200 copies) and 43 (44.3%) had fibrosis scores above F3.

Sixty patients were treated for chronic HCV. Among the 55 untreated patients, 20 (36.4%) were in the process of evaluation, 11 (20%) had uncontrolled HIV viremia (HIV viral load >200 copies) and 9 (16.4%) were actively using illicit substances.

In HCV treated versus HCV untreated patients, it was more common to have an undetectable viral load (60% versus 40%); CD4 count >200 (58% versus 42%); and absence of cocaine abuse (58% versus 42%). Patients who completed HCV treatment had a higher rate of HCC screening (62% versus 33%, p=0.005).

Despite the availability of effective DAA therapy, only one half of co-infected patients were treated for HCV. Providing support and resources to help patients stop using cocaine and encouraging frequent follow up to achieve HIV suppression will “improve access to treatment, decrease mortality and improve the quality of life for this patient group,” the authors wrote.