German cohort of HCV mono-infected and HCV/HIV co-infected patients reveals relative under-treatment of co-infected patients

Abstract

BackgroundCurrent German and European HIV guidelines recommend early evaluation of HCV treatment in all HIV/HCV co-infected patients. However, there are still considerable barriers to initiate HCV therapy in everyday clinical practice. This study evaluates baseline characteristics, “intention-to-treat” pattern and outcome of therapy of HCV/HIV co-infected patients in direct comparison to HCV mono-infected patients in a “real-life” setting.MethodsA large, single-center cohort of 172 unselected HCV patients seen at the Infectious Diseases Unit at the University Medical Center Hamburg-Eppendorf from 2000–2011, 88 of whom HCV/HIV co-infected, was retrospectively analyzed by chart review with special focus on demographic, clinical and virologic aspects as well as treatment outcome.ResultsAntiviral HCV combination therapy with PEG-interferon plus weight-adapted ribavirin was initiated in 88/172 (52%) patients of the entire cohort and in n = 36 (40%) of all HCV/HIV co-infected patients (group A) compared to n = 52 (61%) of the HCV mono-infected group (group B) (p = 0.006). There were no significant differences of the demographics or severity of the liver disease between the two groups with the exception of slightly higher baseline viral loads in group A. A sustained virologic response (SVR) was observed in 50% (n = 18) of all treated HIV/HCV co-infected patients versus 52% (n = 27) of all treated HCV mono-infected patients (p = 0.859). Genotype 1 was the most frequent genotype in both groups (group A: n = 37, group B: n = 49) and the SVR rates for these patients were only slightly lower in the group of co-infected patients (group A: n = 33%, group B: 40% p = 0.626). During the course of treatment HCV/HIV co-infected patients received less ribavirin than mono-infected patients.ConclusionOverall, treatment was only initiated in half of the patients of the entire cohort and in an even smaller proportion of HCV/HIV co-infected patients despite comparable outcome (SVR) and similar baseline characteristics. In the light of newer treatment options, greater efforts to remove the barriers to treatment that still exist for a great proportion of patients especially with HIV/HCV co-infection have to be undertaken.

Retrospective study of hepatitis C outcomes and treatment in HIV co-infected persons from the Australian HIV Observational Database

“…Reported cure rates of 32.4% for genotype 1 and 4, and 69.0% for genotype 2 and 3 are in line with findings from the Swiss HIV Cohort Study (35.2% and 68.4%) 9 and other European studies (31–37.5% and 62.5–87%, respectively), 14,19 and comparable to randomised controlled trials (between 17–29% and 44–62%). 24,25 For pegylated interferon treatment, SVR rates of HIV/HCV co-infected patients are lower than those among HCV mono-infected patients.…”

“…14,18,19 Treatment uptake in Australian co-infected patients was also substantially higher than the 15% or less in the majority of US studies. 10 This may reflect improving treatment options for HCV over time, with our data being more recent than these other studies.…”

Changes in the Profile and Care of HIV-HCV Seropositive Patients in Two Cross-Sectional Surveys in France (2006 and 2013)

“…In both surveys, most treated patients had received the best combination of pegylated interferon and ribavirin. A sustained virological response rate of 50% was noted in the 2013 survey, a figure close to that obtained in other studies in co-infection [44] as well as in HCV mono-infection. Liver transplantation has been approached with caution in HIV-HCV co-infected patients with end-stage liver disease because of concern over the sequelae of immunosuppression and ART-related hepatotoxicity.…”

High hepatic and extrahepatic mortality and low treatment uptake in HCV-coinfected persons in the Swiss HIV cohort study between 2001 and 2013

“…Of these, 39 (27%) were treated early within 6 months after first HCV diagnosis. [16], and in a German and Swedish HIV/HCV cohort treatment rates were 40% and 25%, respectively [17,18]. In a large US cohort of veterans only 12% of monoinfected patients received therapy between 2000 and 2005 [19]; in coinfected populations treatment uptake was even lower [20,21].…”