Hepatitis C Care among HIV Infected Patients in a Community Based Clinic
Improvements in the efficacy and safety of HCV treatments offer hope for HCV cure for many patients. HIV/HCV co-infected patients progress more often and more rapidly to significant liver disease, and thus stand to benefit from prompt treatment of HCV infection. Rates of hepatitis C treatment in patients enrolled in community-based HIV care programs are unknown.
We performed a retrospective cohort analysis of HIV/HCV co-infected adults enrolled in care in the Baltimore City Health Department Early Intervention Initiative program (a Ryan White HIV clinic based in two public sexually transmitted diseases clinics) between 2002 and 2012, with follow-up through March 2014. Data was gathered through retrospective chart review of the electronic medical and paper records.
A total of 217 HIV/HCV infected patients were identified, of whom 102 were engaged in HIV care, defined as having at least two visits in different halves of the year. Patients were engaged in HIV care for a median of 3.6 years (IQR 2-6 years). HIV/HCV co-infected patients had a median age of 45 (IQR 39-50 years) at diagnosis and were predominately African American (89%) and male (79%). The median CD4 count was 422 (IQR 274-617). Fifty-six (55%) of HIV/HCV co-infected patients actively engaged in care were referred to a specialist for HCV treatment, of whom 37 (36%) attended at least one appointment; however, only 8 (8%) were treated for chronic HCV with a cure achieved in 4 (4%). Fifty-two (51%) had evidence of significant fibrosis of whom 16% had cirrhosis based on serum fibrosis markers (FIB 4 >1.44 and >3.25, respectively). Fifty-six (55%) patients in this cohort achieved virologic HIV suppression based on an HIV viral load <200copies.
In this urban community-based HIV clinic with significant HCV-related liver disease, rates of attendance for HCV specialty appointments and anti-HCV treatment were extremely low. Conversely, over half of co-infected patients achieved HIV viral load suppression. In the era of oral anti-HCV treatments, where a key predictor of treatment success will be treatment adherence, provision of HCV treatment and care by community HIV providers, who have demonstrated experience in maintaining patients on HIV therapy, may lead to higher rates of HCV treatment initiation and cure.
K. Page, None
C. P. Chaulk, None
W. China, None
O. Falade-Nwulia, None