Treatment of Hepatitis C Virus and Human Immunodeficiency Virus Coinfection: Fro

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From Journal of Viral Hepatitis

Treatment of Hepatitis C Virus and Human Immunodeficiency Virus Coinfection:

From Large Trials to Real Life

Posted 10/30/2006

P. Cacoub; E. Rosenthal; P. Halfon; D. Sene; C. Perronne; S. Pol

Summary and Introduction

Summary

To analyse the barriers for anti-hepatitis C virus (anti-HCV) treatment in

human immunodeficiency virus (HIV)-HCV coinfected patients, we surveyed 71

physicians specializing in infectious disease (39%), internal medicine

(27%), HIV/AIDS information and care (17%), haematology (10%) and hepatology

(6%). A standard data collection form was used to identify patients observed

in 7 days in November 2004. Three hundred and eighty patients with the

following characteristics were included: male gender 71%; mean age 41.5

years; HIV diagnosed 12 years ago; routes of transmission via injection drug

use (78%); undetectable HIV viral load (235/373, 63%) or <10 000 copies/mL

(86/373, 23%). HCV RNA was positive in 325 of 369 (88%) patients; HCV

genotype was 1 or 4 in 65% and liver biopsy had been carried out in 56%.

There were several explanations for the nontreatment of HCV in 205 of the

380 (54%) patients, with 2.4 reasons per patient: anti-HCV treatment was

deemed questionable (n = 109) because of minor hepatic lesions, alcohol

consumption, or active drug use; no liver biopsy had been performed (n =

68); treatment was contraindicated (n = 62), mainly for psychiatric reasons;

there was physician conviction of poor patient compliance (n = 62) and

patient refusal (n = 33). Patients having received anti-HCV treatment (n =

91) compared with those who had never received any (n = 205) were more

commonly of European origin, had better control of their HIV infection, were

followed by a hepatologist more often, had a liver biopsy more often and had

more commonly a high HCV viral load (P < 0.001). In 'real life' in France in

2004, more than half of the HIV-HCV coinfected patients have never received

anti-HCV treatment. The main reasons are a treatment that may be deemed

questionable (minimal hepatic lesions, alcohol, active drug use), a lack of

available liver biopsy, a psychiatric contraindication and physician

conviction of poor patient compliance.

Introduction

Coinfection with hepatitis C virus (HCV) and human immunodeficiency virus

(HIV) is a frequent and particularly a serious problem.[1-7] About 30% of

HIV-infected patients in France are also infected with HCV, representing

close to 30 000 patients.[1,2,8,9] As the widespread use of highly active

antiretroviral therapy (HAART), AIDS mortality has progressively decreased,

while chronic hepatopathies, linked primarily to HCV, have become one of the

leading causes of morbidity and mortality.[2,5,10]

Considerable therapeutic progress has been achieved in those coinfected

patients because of anti-HCV combination therapy that employs standard

interferon and ribavirin,[11-13] and more recently pegylated interferon and

ribavirin.[14-16] This latter combination produces sustained virological

responses in 55-60% of patients infected with HCV only. Recent published

results from several large therapeutic trials in coinfected patients have

provided important information.[17-20] A particularly encouraging result was

that the pegylated interferon plus ribavirin combination showed better

results than that of the standard interferon/ribavirin combination. A

sustained virological response was obtained in 27-44% of coinfected

patients, the majority of whom also had hepatic histological improvement.

Despite the frequency and seriousness of HIV-HCV coinfection and recent

therapeutic advances that have been made, the access to anti-HCV treatment

in HIV-HCV coinfected patients remains limited to a small number of

patients.[21,22] The aim of this study was to analyse the barriers to the

utilization of anti-HCV treatment in HIV-HCV coinfected patients in France

in 2004.

FULL TEXT: http://www.medscape.com/viewarticle/545152?src=mp

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