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.
Highlights
Current German and European HIV guidelines recommend early evaluation of HCV treatment in all HIV/HCV co-infected patients
All patients presented at the Infectious Diseases Outpatient Clinic of the University Medical Center Hamburg-Eppendorf, Germany in the time period from 2000 – 2011 -before directly acting antivirals (DAA’s) became readily available for the treatment of HIV/HCV co-infection
We analyzed a total number of 172 treatment-naïve patients with chronic hepatitis C infection
Summary
Current German and European HIV guidelines recommend early evaluation of HCV treatment in all HIV/HCV co-infected patients. 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. HIV co-infection may worsen the course of hepatitis C infection, leading to faster progression of liver fibrosis related factors can effect the response to treatment, but in general more than 50% of naïve mono-infected patients will achieve sustained virologic response (SVR) with the current standard therapy (pegylated interferon plus ribavirin) [6,7]. Higher baseline HCV RNA levels and lower initial ribavirin doses are quoted as possible explanation for the lower SVR seen in co-infected patients [13]. Less is known about the “real life” treatment outcome of co-infected patients [15]
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