Background: Many health care payers currently restrict access to hepatitis c virus (HCV) medications for HIV-infected patients with ongoing barriers to care in the absence of clinical data regarding HCV treatment outcomes in the era of direct acting antivirals (DAA) against HCV.
Methods: We described HCV treatment outcomes using DAA regimens and an inclusive treatment protocol in a HIV-clinic with many patients with ongoing barriers to care (unstable housing, neuropsychiatric disease, ongoing drug and/or alcohol use). HCV treatment was initiated when patients showed consistent undetectable HIV viral loads and compliance with scheduled clinic visits irrespective of ongoing barriers. Using a random-effects model meta-analytic approach, we compared the proportion of HIV-infected patients cured of HCV in the dual era [pegylated interferon (peg-IFN) plus ribavirin, 2008-2011]; triple-therapy era (peg-IFN plus ribavirin and telaprevir, 2011-2013); and DAA era (2014).
Results: Thirty HIV/HCV patients of whom 16 (53%) had ongoing barriers to care were treated for HCV using DAA regimens and overall 83.3% were cured. Similar proportions of patients with ongoing barriers to care were treated during the dual [25/39 (64%)] and triple-therapy [14/25 (56%)] eras. The probability of HCV cure in in the dual, triple-therapy and DAA eras increased from 39% (95% CI: 33-45), 48% (95% CI: 40-56) to 85% (95% CI: 80-90), respectively. Patients with and without ongoing barriers to care who fulfilled our HCV treatment eligibility protocol had similar chances of HCV cure during each of the three treatment eras as other patients with known predictors of HCV treatment response (figures 1-3). Chances of HCV cure among patients with ongoing barriers to care improved considerably in DAA era, from 40 (95% CI: 21-61) to 75% (95% CI: 48-93) in the dual and DAA-era, respectively. HCV treatment interruption and/or lost to follow-up due to ongoing barriers to care were infrequent with 3 of 39 (8%), 2 of 25 (8%) and 0 of 30, in the dual, triple-therapy and DAA eras, respectively. Since 2008, two patients were reinfected with HCV after they were cured.
Conclusion: Using DAA regimens and an inclusive HCV treatment protocol 75% of HIV/HCV treated patients with ongoing barriers to care were cured of HCV.
BMS: Consultant and Investigator , Consulting fee and Research support
Gilead: Investigator , Research support
Merck: Investigator , Research support
Tacere: Investigator , Research support
L. Hill, None
C. Ballard, None
F. Torriani, None
B. Colwell, None
A. Kuo, Gilead: Scientific Advisor , Research grant and Research support
R. Schooley, Gilead: Investigator , Research support
W. C. Mathews, None
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