Abstract
Background: Due to overlap ways of transmission, HIV and hepatitis C (HCV) co-infection is highly prevalent. The aim of this study was to characterize the HCV cascade of care among HIV/HCV infected individuals in a major HIV center in Buenos Aires, Argentina. Methods & Materials: Data was drawn from Electronic Medical Records of HIV/HCV co-infected individuals. We assessed the number and proportion of patients achieving each step of the HCV cascade: RNA confirmation, fibrosis staging, treatment initiation, treatment completion, and sustained virological response (SVR). Results: Of the estimated 1650 HIV/HCV co-infected individuals, only 803 (49%) were actually tested for HCV antibody. Only 355/1650 (21%) were tested for HCV-RNA, of whom 320 were positive, confirming chronic infection (90%). Meanwhile, 46/1650 (3%) had only fibrosis staging. Among the 320 patients with positive RNA, 243 (76%) underwent fibrosis staging, and in 119 (37%) treatment was prescribed. Of them, 42 (35%) had received interferon-based therapy (the only drugs available before 2016), 34 (29%) received direct-acting antivirals (DAA), and 43 (36%) are going to initiate treatment with DAA this year. Among the 76 patients that completed treatment, 57 (75%) achieved SVR. Of the 34 individuals who received DAA, 100% achieved SVR. Conclusion: In accordance to what has been reported worldwide, we observed gaps in our HCV care cascade. In particular, large gaps were documented at the diagnostic stages, with less than a quarter actually receiving RNA confirmation. These results highlight the need to identify and address barriers that are preventing our HCV/HIV co-infected populations from benefitting from highly efficacious newer DAA-based treatments. It is crucial to generate awareness about the importance of active search of HCV coinfection in HIV patients, and the steps required to complete HCV evaluation and treatment. This goal can mainly be achieved by a continuous medical and patient education.
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