Insights on treatment of a Portuguese cohort of HCV/HIV coinfected patients

Abstract

Purpose of the studyThis study intends to characterize a Portuguese patient population with chronic HCV and HIV coinfection, followed at our Research Unit, underline the importance of early treatment and incorporate the importance of DDA for retreatment of HCV infection.MethodsRetrospective, observational analysis of medical records of 348 HCV/HIV coinfected patients from 2001 to 2011. Demographic, epidemiological, clinical and laboratory data and virologic response were collected.Summary of resultsReview of 348 HCV/HIV coinfected patients, 121 of those (34.7%) under treatment, predominantly male (77.0%) and Caucasians (94.8%) with a median age of 44 yrs old (min 25; max 77 yrs). Intravenous drug use was the main route of HCV infection, in 71.3% of patients, and 8.3% were related with MSM. Frequent morbidities were alcohol abuse (46.8%), illicit drug use (70.1%), methadone (25.6%) and mental disturbances (12.3%) of patients. Regarding HIV infection, six were HIV‐2 and 342 HIV‐1; 36.1% were stage A and 29.6% were stage C (CDC Atlanta), 94.8% on antiretroviral treatment and only 21.9% of them with more than 350 TCD4 cell count. Genotype 1 was the most prevalent (58.1%–117 genotype 1a, 26 genotype 1b); 1.6% were genotype 2, 22.8% genotype 3 and 17.5% genotype 4. Previous to treatment initiation, HCV ARN was above 600.000 IU/mL in 56.9% patients. Fibrosis was evaluated by fibroelastography in 41.1% and hepatic biopsy in 26.3% of patients; in those, 44.0% had a score above F2 (METAVIR) and ALT was elevated 2 times the limit in 38.0%, with an average value of 94 UI/L. IL 28B testing was performed in only 35 patients at the time, with 45.7% CC and 17.1% CT genotype. Treatment was started in 34.8% of patients, with 1.7 treatments per individual, and regimen was based on peguilated interferon with ribavirin in 93.6% of cases (72.1% with peginterferon alfa 2a). The SVR rate was 51.2%, with 28.9% non responders, 3 relapsers and 9 treatment interruptions due to major toxicities.ConclusionsOur data presents a low HCV treatment initiation, illustrated by 65.2% patients who did not begin any treatment. The majority completed treatment and the SVR rate was similar to literature. Individualized approach is essential to determine the optimal time to initiate HCV treatment, to assess patient adherence and adverse events management, in order to optimize treatment and reserve DDA drugs to experienced patients with worse predictive factors.