Factors Associated With Guideline-based Hepatitis C Virus (HCV) Treatment Initiation in HIV/HCV-coinfected Patients

Role of Comorbidities and Physicians' Perceptions

M Winnock, F Bani-Sadr, E Pambrun, M-A Loko, P Carrieri, D Neau, P Morlat, B Marchou, F Dabis and D Salmon

Disclosures

HIV Medicine. 2013;14(7):430-436. 

In This Article

Abstract and Introduction

Abstract

Objectives Many HIV-infected patients with chronic hepatitis C virus (HCV) infection do not receive treatment for HCV infection, often because of contraindications or poor adherence to anti-HIV therapy. The aim of this study was to identify factors influencing guideline-based HCV treatment initiation in a large cohort of HIV/HCV-coinfected patients.

Methods Between 2005 and 2011, 194 (40.5%) of 479 coinfected patients not previously treated for HCV infection started this treatment based on current recommendations, i.e. a Metavir score > F1 for liver fibrosis; HCV genotype 2 or 3 infection; or HCV genotype 1 or 4 infection and low HCV viral load (< 800 000 IU/mL), whatever the fibrosis score. Clinical and biological data were compared between patients who started HCV therapy during follow-up and those who did not.

Results In multivariate analyses, good adherence to treatment for HIV infection, as judged by the patient's physician, was associated with HCV treatment initiation [odds ratio (OR) 2.37; 95% confidence interval (CI) 1.17–4.81; P = 0.017], whereas patients with children (OR 0.53; 95% CI 0.30–0.91; P = 0.022) and those with cardiovascular disease or respiratory distress (OR 0.10; 95% CI 0.01–0.78; P = 0.03) were less likely to be treated.

Conclusions Adherence to treatment for HIV infection, as judged by the patient's physician, appears to have a major influence on the decision to begin treatment for HCV infection in coinfected patients. This calls for specific therapeutic education and adherence support in order to ensure timely anti-HCV therapy in this population.

Introduction

Compared with isolated hepatitis C virus (HCV) infection, concurrent infection by HIV and HCV results in more rapid progression towards cirrhosis and liver failure.[1,2] In the last decade, chronic liver disease, mainly resulting from HCV infection, has become one of the leading causes of morbidity and mortality in HIV-infected patients.[3] In the first published trials of anti-HCV therapy in this setting, the pegylated interferon alpha (peg-interferon) and ribavirin combination was less effective in HIV-coinfected patients. Sustained virological response (SVR) rates ranged from 14 to 38% among patients with HCV genotype 1 infection and from 44 to 73% among those with genotype 2 or 3 infection.[4,5] However, markedly higher SVR rates among coinfected patients, reaching more than 50%, have been observed in clinical practice in the last few years.[6] Furthermore, SVR has been found to have major benefits in HIV/HCV-coinfected patients, with slower progression of fibrosis, less frequent severe liver toxicity of antiretroviral therapy, and a reduction in liver-related complications and mortality.[1,7] Under-treatment of chronic HCV infection in HIV-infected patients remains frequent, however, for several reasons, including contraindications, patient refusal and poor adherence.[6,8,9] The French Expert Group recommendations for medical management of HIV infection advised the use of peg-interferon plus ribavirin combination therapy for patients with stage ≥ F2 fibrosis and, whatever the fibrosis score, for patients with a high likelihood of achieving an SVR, i.e. patients infected with genotype 2 or 3 and those infected with genotype 1 or 4 who have a low viral load (< 800 000 IU/mL).[10] The aim of this study was to identify factors associated with guideline-based HCV treatment initiation in a large cohort of HIV/HCV-coinfected patients.

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