Barriers to Hepatitis C Treatment in an HIV-HCV Co-Infected Cohort

Infectious Disease Week (IDWeek)
October 2-6, 2013
San Francisco, Ca

470. Barriers to Hepatitis C Treatment in an HIV-HCV Co-Infected Cohort

Session: Poster Abstract Session: Prevention and Treatment of Viral Infections

Thursday, October 3, 2013

Room: The Moscone Center: Poster Hall C

Posters IDSA_2013_NU-VHR_txbarriers_final(2).pdf (250.6 kB)

Background: Hepatitis C virus (HCV)-related liver disease has emerged as a leading cause of morbidity and mortality in HIV patients (pts). HCV therapy (HCV-RX) may reduce progression of liver fibrosis and liver related death in these pts.

Methods: Northwestern University Viral Hepatitis Registry (NU-VHR) and HIV Outpatient Study (N-HOPS) are prospective observational cohorts of ambulatory HIV pts recruited from our outpatient HIV Center.  We queried both databases for pts with chronic HCV infection (≥ 1 detectable HCV RNA) in order to define the epidemiology of HCV infection in our center and determine barriers to HCV-RX. 

Results: We identified 102 pts with chronic HCV, 90% had genotype 1. The median age was 52 years. 44 pts (43%) received HCV-RX, 18 (41%) achieved sustained virologic response.  Demographic and clinical characteristics are described in Table 1. Barriers to HCV-RX of untreated pts are listed in Table 2.

Table 1

	Never treated (n 59)		Treated* (n 44)
Characteristic	n	%	n	%
Male	42	71	38	86
Caucasian	20	34	30	68
Risk factor for HCV
Recreational drug use	31	54	16	42
MSM	16	28	15	39
Hemophilia	12	21	9	24
CD4 <200 cells/ml	12	20	1	2
History of heavy alcohol use	13	22	5	11
Positive HBsAg or HBV DNA	2	3	3	7
Liver biopsy done at least once	27	46	34	77
Advanced fibrosis (METAVIR >2)	9	32	10	30

*38 pts received peg-interferon + ribavirin (PEG-IFN/RBV), 6 received PEG-IFN/RBV plus Boceprivir

Table 2

Reason(s) for not initiating HCV-RX*	n	%
Non-adherence with hepatology evaluation	12	20
Treatment not recommended based on absence of liver fibrosis on clinical assessment and/or liver biopsy	11	19
Comorbid or medical contraindications Τ	9	15
Active psychiatric illness	8	14
Lost to follow up	6	10
Active substance use	6	10
Patient declined therapy	6	7
Non-adherence with HIV provider visits and/or HAART	2	3

* Some pts have ≥ 1; ^Τ CD4 count < 200, renal insufficiency, etc.

Conclusion: In this urban HIV-HCV co-infection cohort, only 43% of HIV-HCV infected pts have received HCV-RX, and 82% have ongoing infection. The major barriers to HCV-RX were poor adherence with hepatology evaluation and low uptake of therapy for patients that are eligible for treatment. Infectious Disease centered HCV-TX might provide better opportunities for treatment.

Guajira Thomas, MD¹, Claudia Hawkins, MD², Sudhir Penugonda, MD MPH¹, Michael Angarone, DO¹, Frank Palella, MD³ and Valentina Stosor, MD¹, (1)Northwestern University Feinberg School of Medicine, Chicago, IL, (2)Northwestern University Feinburg School of Medicine, Chicago, IL, (3)Northwestern University, Chicago, IL

Disclosures:

G. Thomas, None

C. Hawkins, None

S. Penugonda, None

M. Angarone, None

F. Palella, Merk: Consultant and Speaker's Bureau, Consulting fee and Speaker honorarium
Gilead Sciences: Consultant and Speaker's Bureau, Consulting fee and Speaker honorarium
Janssen Pharmaceuticals: Consultant and Speaker's Bureau, Consulting fee and Speaker honorarium
Bristol-Myers Squibb: Consultant and Shareholder, Consulting fee and Speaker honorarium

V. Stosor, None

Source