470. Barriers to Hepatitis C Treatment in an HIV-HCV Co-Infected Cohort
Session: Poster Abstract Session: Prevention and Treatment of Viral Infections
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDSA_2013_NU-VHR_txbarriers_final(2).pdf (250.6 kB)
  • Background: Hepatitis C virus (HCV)-related liver disease has emerged as a leading cause of morbidity and mortality in HIV patients (pts). HCV therapy (HCV-RX) may reduce progression of liver fibrosis and liver related death in these pts.

    Methods: Northwestern University Viral Hepatitis Registry (NU-VHR) and HIV Outpatient Study (N-HOPS) are prospective observational cohorts of ambulatory HIV pts recruited from our outpatient HIV Center.  We queried both databases for pts with chronic HCV infection (≥ 1 detectable HCV RNA) in order to define the epidemiology of HCV infection in our center and determine barriers to HCV-RX. 

    Results:

    We identified 102 pts with chronic HCV, 90% had genotype 1. The median age was 52 years. 44 pts (43%) received HCV-RX, 18 (41%) achieved sustained virologic response.  Demographic and clinical characteristics are described in Table 1. Barriers to HCV-RX of untreated pts are listed in Table 2.

    Table 1

    Never treated (n 59)

    Treated*

    (n 44)

     Characteristic

    n

    %

    n

    %

    Male

    42

    71

    38

    86

    Caucasian

    20

    34

    30

    68

    Risk factor for HCV

         Recreational drug use

    31

    54

    16

    42

         MSM

    16

    28

    15

    39

         Hemophilia

    12

    21

    9

    24

    CD4 <200 cells/ml

    12

    20

    1

    2

    History of heavy alcohol use

    13

    22

    5

    11

    Positive HBsAg or HBV DNA

    2

    3

    3

    7

    Liver biopsy done at least once

    27

    46

    34

    77

    Advanced fibrosis (METAVIR >2)

    9

    32

    10

    30

    *38 pts received peg-interferon + ribavirin (PEG-IFN/RBV), 6 received PEG-IFN/RBV

     plus Boceprivir

    Table 2

    Reason(s) for not initiating HCV-RX*

    n

    %

    Non-adherence with hepatology evaluation

    12

    20

    Treatment not recommended based on absence of liver fibrosis on clinical assessment and/or liver biopsy

    11

    19

    Comorbid or medical contraindications Τ

    9

    15

    Active psychiatric illness

    8

    14

    Lost to follow up

    6

    10

    Active substance use

    6

    10

    Patient declined therapy

    6

    7

    Non-adherence with HIV provider visits and/or HAART

    2

    3

    * Some pts have ≥ 1; Τ CD4 count < 200, renal insufficiency, etc.

    Conclusion: In this urban HIV-HCV co-infection cohort, only 43% of HIV-HCV infected pts have received HCV-RX, and 82% have ongoing infection. The major barriers to HCV-RX were poor adherence with hepatology evaluation and low uptake of therapy for patients that are eligible for treatment. Infectious Disease centered HCV-TX might provide better opportunities for treatment.

    Guajira Thomas, MD1, Claudia Hawkins, MD2, Sudhir Penugonda, MD MPH1, Michael Angarone, DO1, Frank Palella, MD3 and Valentina Stosor, MD1, (1)Northwestern University Feinberg School of Medicine, Chicago, IL, (2)Northwestern University Feinburg School of Medicine, Chicago, IL, (3)Northwestern University, Chicago, IL

    Disclosures:

    G. Thomas, None

    C. Hawkins, None

    S. Penugonda, None

    M. Angarone, None

    F. Palella, Merk: Consultant and Speaker's Bureau, Consulting fee and Speaker honorarium
    Gilead Sciences: Consultant and Speaker's Bureau, Consulting fee and Speaker honorarium
    Janssen Pharmaceuticals: Consultant and Speaker's Bureau, Consulting fee and Speaker honorarium
    Bristol-Myers Squibb: Consultant and Shareholder, Consulting fee and Speaker honorarium

    V. Stosor, None

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