CV diagnosis and direct-acting antiviral agents -based treatment for HIV/HCV co-infected patients in a primary care setting in Maputo, Mozambique

Abstract

Background: Direct-acting antiviral agents (DAAs) treatment has been associated with high rates of sustained virological response at week 12 after treatment completion (SVR12) and a good safety profile in HIV + /HCV + individuals in clinical trials. We aimed to assess the HCV diagnosis and DAA-based treatment feasibility in a Minister of Health (MoH) primary care setting in Maputo, Mozambique. Methods & Materials: We included for analysis the active cohort of HIV-positive adults enrolled for HIV care between March 2015-July 2017 in MSF supported MoH HIV clinic in a primary health centre in Maputo, Mozambique. Results: Among 1486 active patients enrolled between March 2015-July 2017, 1334 (90%) were screened for HCV antibodies (OraQuick HCV Rapid Antibody Test, OraSure Technologies, Bethlehem, USA): 81 (6%) patients tested antibodies positive, among them 83% had viral load (VL) detectable. GNT 1a was detected in 90% of cases, 8% were GNT 4, and 2% were GNT 3. Among patiens with HCV VL detectable, 87% were men, with a mean age of 37 years old, and 90% had a history of injectable drugs abuse. The fibrosis score by Fibroscan® was F0-F1 for 82% of patients, F2-F3 for 10%, F3-F4 for 8%. A total of 21 HIV/HCV patients were initiated on DAAs from December 2016 up to October 2017 and 15 of them completed treatment. All patients were on antiretroviral treatment at HCV treatment initiation, 35% on second line regimen (with Lopinavir/ritonavir). No severe side effects were reported. No defaulters or treatment discontinuation in this cohort. VL follow-up 12 weeks after the end of treatment was done for 4 patients: 3 patients with SVR12 achieved and one failure. Conclusion: This is the first experience of HCV treatment with DAAs in the primary care setting in public health sector in Mozambique. Injectable drugs use appears as main risk factor for HCV infection. A more comprehensive package of care with targeted testing, harm reduction interventions and treatment need to be offered to most at risk population. Inclusion of HCV routine diagnosis followed by access to treatment by new DAAs in primary HIV care setting in Maputo, mozambique, is feasible.