Why don't we treat chronic hepatitis C in HIV patients? Results from a cohort of HIV‐HCV coinfected patients from the southeast of Spain

Abstract

Purpose of the study To know the different reasons why we decide not to treat or to delay the antiviral treatment against HCV in HIV coinfected patients. Methods Prospective cohort of HIV and HCV coinfected patients, followed in the Infectious Diseases Department of the Santa Lucia Universitary Hospital (Cartagena, Spain) between 1/12/2011 and 28/02/2012 in which we made transitory elastography. We evaluated the main reasons that moved us to decide not to treat or to delay the antiviral treatment against HCV: social‐familiar‐laboral reasons; neuro‐psychiatric severe diseases; patient decision; low grade hepatic fibrosis; previous failure to pegylated interferon (IFN) and ribavirin (RBV) in no‐1 genotype patients; delay in the approval of the triple therapy with INF‐RBV and a protease inhibitor (boceprevir or telaprevir) by the Regional Sanitary Authority; active alcohol abuse; active diseases that contraindicate the antiviral treatment, incomplete study of HCV (VL of HCV, genotype, ILB28, abdominal ecography); previous intolerance against IFN‐RBV and severe thrombocytopenia (<50×109/L). Summary of results The cohort included 109 patients, being 27 of them females (25%) and 82 males (75%), with a median of age of 45.8 years (SD: 6.2). In 98 patients (90%) we decided not to treat or to delay the antiviral treatment against HCV for one or more of the following reasons: 37 (34%) presented low grade hepatic fibrosis (<9.5 kpascal or F0‐F2); 19 (17%) had neuro‐psychiatric diseases; 18 (16.5%) were waiting for the approval of triple therapy by the Regional Sanitary Authority; 10 (9.2%) did not want to be treated; 10 (9.2%) had failure to IFN‐RBV in no‐1 genotype; 6 (5.5%) had social‐familiar‐laboral reasons; 6 (5.5%) presented active severe diseases; 4 (3.7%) were waiting to complete HCV study; 3 (2.8%) presented active alcohol abuse; 3 (2.8%) had previous intolerance against IFN‐RBV treatment and 2 (2%) had severe thrombocytopenia. Conclusions In our cohort of HIV‐HCV coinfected patients it was decided to delay or not to treat chronic hepatitis C in a significant proportion of subjects. The low grade of hepatic fibrosis measured with transitory elastography was the main reason for delaying the HCV antiviral treatment. The neuro‐psychiatric disease was the main clinical reason to not treat HCV. The delay of the approval of triple therapy treatment by the Regional Sanitary Authority was the most relevant non‐ clinical reason in our prospective study.