Comparison of the Hepatitis C Continua of Care Between Hepatitis C Virus/HIV Coinfected and Hepatitis C Virus Mono-Infected Patients in Two Treatment Eras During 2008–2015

Abstract

Treatment of chronic hepatitis C virus (HCV) infection included use of pegylated interferon-based regimens before 2014 and direct-acting agents (DAA) since 2014 at the VA Medical Center in Washington, DC. We compared the continua of care between our HCV/HIV coinfected and HCV mono-infected patients during 2008-2015. A review of summary data from our local HCV Clinical Case Registry was conducted for the interferon treatment era (2008-2013) and the DAA era (2014-2015). Data were analyzed on a modified HCV Continuum of Care based on these stages: HCV diagnosis, engagement in medical care, HCV treatment, and HCV sustained virologic response (SVR) for differences between HCV/HIV coinfected and HCV mono-infected patients. All patients had 88% engagement in primary care during 2008-2013. HCV mono-infected and HCV/HIV coinfected patients had similar treatment (6% vs. 5%, p = .6622) and HCV SVR (1% vs. 0.5%, p = .1737) rates in the interferon era. However, more HCV/HIV coinfected patients were engaged in care (93% vs. 87%, p = .0044), accessed HCV treatment (36% vs. 23%, p < .0001), and achieved HCV SVR (31% vs. 21% p = .0002) compared to mono-infected patients in the DAA era. Both HCV/HIV coinfected and HCV mono-infected patients achieved higher SVR of ≥86% after DAA treatment. Although improvements were seen for treatment and SVR among HCV mono-infected patients, better rates for care engagement, HCV treatment, and SVR were realized for HCV/HIV coinfected patients in the DAA era.

Race and Hepatitis C Care Continuum in an Underserved Birth Cohort

“…The proportion of patients without documented SVR testing to confirm cure following treatment was relatively low, but we identified the absence of HIV co-infection and younger age as factors associated with lack of SVR testing. This may be related to a higher rate of engagement in primary care among HIV/HCV co-infected patients 40 and older patients. Therefore, ongoing engagement in medical care along with emphasis on the importance of confirmatory SVR testing especially in the younger birth cohort patients will be critical to enhancing documentation of HCV treatment response in this population.…”

Epidemiological trends in HCV transmission and prevalence in the Viennese HIV+ population

“…While response to DAA treatment in HIV/HCV coinfected patients tended to be lower in the early DAA era, modern HCV DAA regimens yield SVR rates in HIV/HCV coinfected patients of >95%, and thus, HIV/HCV coinfected patients no longer represent a ‘difficult‐to‐cure’ patient population . We observed a response rate of 64.7% (22/34) to PEGIFN‐based treatment vs 87.5% (49/56) to DAA‐based regimens in our study cohort.…”

“…Modern DAA‐based HCV therapy results in SVR rates >95% across all HCV genotypes and HIV coinfected patients . While the historic HCV treatment with pegylated interferon (PEGIFN) and ribavirin (RBV) showed only modest SVR rates and was limited by various patient characteristics, the introduction of DAAs now enables curative treatment at a favourable tolerability in HIV/HCV coinfected individuals including HIV+ patients with acute hepatitis C as well as patients with cirrhosis and prior HCV treatment failure …”

“…1,2, 15 While the historic HCV treatment with pegylated interferon (PEGIFN) and ribavirin (RBV) showed only modest SVR rates and was limited by various patient characteristics, [16][17][18][19] the introduction of DAAs now enables curative treatment at a favourable tolerability in HIV/HCV coinfected individuals including HIV+ patients with acute hepatitis C as well as patients with cirrhosis and prior HCV treatment failure. [20][21][22][23][24][25][26][27][28] Yet, the HCV-associated burden of disease remains high in HIV patients and efforts are needed to expand screening and treatment as well as provide education on risk factors for HCV transmission and effective treatment options. 1,11,[29][30][31][32][33][34] The unrestricted access to novel DAA-regimens in Vienna since September 2017 marked an important step towards the World Health Organization (WHO)-goal of HCV elimination by 2030.…”

Validation of a modified Berger HIV stigma scale for use among patients with hepatitis C virus (HCV) infection

“…HCV-associated mortality now exceeds death from 60 other combined notifiable infectious diseases, including human immunodeficiency virus (HIV) infection [2]. Despite national action plans to eliminate HCV infection as a major public health threat by 2030 [5][6][7], fewer than half of HCV-infected persons in the US have been diagnosed or are aware of their infection [8], and treatment uptake remains <15% [9][10][11][12][13], undermining public health efforts.…”