Considerable Under-Treatment of Chronic HCV Infection in HIV Patients despite Acceptable Sustained Virological Response Rates in a Real-Life Setting

Abstract

Background

According to guidelines, treatment of HCV infection should be considered a priority in HIV–HCV-coinfected patients.

Methods

This multicentre study includes HIV–HCV-coinfected patients diagnosed since 2001 in 14 participating centres in Austria and Germany. Demographic and virological data were recorded. Factors associated with non-initiation of HCV treatment were identified.

Results

Among 9,524 HIV patients screened, 1,033 HIV– HCV-coinfected patients were identified (male/female: 760/273; age: 43 ±9 years; weight: 71 ±12 kg; CD4⁺ T-cell nadir: 255 ±189 cells/μl; HCV RNA: 3.79x10⁶ IU/ml; HIV RNA: 65x10³ copies/ml). HCV genotype (GT) was predominantly GT-1 (62%). A total of 416 (40%) patients received HCV treatment, whereas 617 (60%) patients remained untreated. The main reasons for deferral of HCV treatment were patient refusal (20%), adherence/compliance (18%), active intravenous drug abuse (14%) and advanced immunodeficiency/AIDS (9%). Patients starting HCV treatment had significantly lower fibrosis stage (F2 versus F4; P<0.0001), higher CD4⁺ T-cell count (530 cells/|il versus 430 cells/|il; P<0.0001), lower HIV RNA levels (18x10³ copies/ml versus 47x10³ copies/ml; P=0.0008) and higher alanine aminotransferase (ALT; 113 IU/ml versus 75 IU/ml; P<0.0001) than patients without initiation of HCV treatment. Age, HCV GTs, HCV RNA, haemoglobin levels, platelet count and white blood cell count were similar in patients receiving and in patients not receiving antiviral therapy. Multivariate analysis identified ALT levels (P<0.0001) and CD4⁺ T-cell count (P<0.0001) as independent predictors of treatment uptake. The overall sustained virological response (SVR) was 41% (155/416), with GT-1 and non-GT1 patients achieving SVR rates of 29% and 48%, respectively.

Conclusions

This large cohort study provides evidence for considerable under-treatment of chronic HCV infection in HIV patients. Despite acceptable treatment success in this real-life setting, HCV remains untreated in the majority of patients and often owing to potentially modifable reasons.

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