HIV/hepatitis C co-infection: Successfully treating hepatitis C with direct-acting antivirals and managing those who do not access traditional care

Rebecca Metcalfe, Naomi Bulteel, Joe Schofield, Patricia McGinness, Claire Glover, Lorna McLean, Fiona Marra, Aliceann Murphy, Erica Peters, David Bell, Ray Fox, Emma Thomson

Research output: Contribution to journalMeeting abstractpeer-review

Abstract / Description of output

Introduction: In our HIV/hepatitis C virus (HCV) co-infected cohort, we are successfully treating HCV with direct-acting antivirals (DAAs) regardless of genotype, regimen, disease stage or prior treatment exposure. However, we recognize a proportion of patients for whom we are unable to provide treatment, because they do not engage in the traditional care setting. We report on the efficacy and safety of DAA therapy in our cohort of HIV/HCV co-infected individuals, the demographics of those not engaging in care and the strategies employed to tackle this population.

Methods: All patients co-infected with HIV and HCV in our cohort were included, and case notes were reviewed. Those who spontaneously cleared HCV infection, transferred care or died were excluded.

Results: At May 2016, the HIV/HCV co-infected cohort comprised 181 patients, of whom 89 (49%) had commenced HCV treatment. Thirty-three of these patients were treated successfully with interferon and ribavirin. Fifty-seven patients received ≥1 dose second-generation DAA, including 20 patients with cirrhosis, six in clinical trials. The majority were male (46/57) with a history of injecting drug use (35/57). The majority were HCV genotype 1 infected (48/57). Most were treatment naïve (43/57); six prior null responders; four relapsers after previous IFN/RBV; none were DAA experienced. Fifty-five of 57 were on a suppressive HIV antiretroviral regimen. At the time of writing, 52/57 patients had reached end of treatment. Forty-two had achieved SVR12 (42/42, 100%). Despite high success rates with those engaged in care, 92 (51%) patients remain untreated, of whom the majority are not attending scheduled hospital appointments, and many are currently struggling with addictions. Some are recently diagnosed as part of an ongoing outbreak of HIV and HCV amongst people who inject drugs. To target this population, we are implementing service change. New strategies will include local pharmacy “directly observed therapy” dispensing, specialist nurse-led service in the community and in addiction services. We show the area of residence of those who have over 50% non-attendance rates, in relation to the hospital where care is traditionally delivered to highlight the need for local services.

Conclusions: In those who access care, we observe excellent SVR rates in HIV-infected patients receiving DAAs for HCV. Serious adverse events with DAAs are rare and delivering treatment in the community to difficult-to-treat populations will increase engagement in HIV care and HCV cure rates. Poor engagement in care should be tackled by service redesign to reach out to these populations.
Original languageEnglish
Pages (from-to)195
Number of pages1
JournalJournal of the International AIDS Society
Volume19
Issue numberS7
DOIs
Publication statusPublished - 23 Oct 2016

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