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Purpose of the study: To know the main epidemiological, virological and therapeutic characteristics of HCV infection and the degree of hepatic fibrosis in a cohort of HIV-HCV co-infected patients in a health area of southeastern of Spain. Methods: Prospective cohort of co-infected HIV-HCV patients followed in the University Hospital of Saint Lucia (Spain), which describes the main epidemiological characteristics, degree of liver fibrosis assessed by transient elastography and the level of response to treatment for HCV during the period November 30, 2011–February 28, 2012. Summary of results: The cohort included 109 patients, of whom 27 were females (25%) and 82 males (75%), with a mean age of 45.8 (SD: 6.2) years and a mean time of infection of 18.8 (SD: 5.7) years. The main route of transmission was in this order: IDUs in 90 patients (83%), 13 (12%) by heterosexual intercourse and 3 (2.8%) in MSM. There were no statistically significant differences between the years of evolution of HCV based on the route of transmission (p=0.36). In the genotypic analysis, 55 patients were genotype 1a (51%), 13 genotype 1b (13%), 19 genotype 3 (17%) and 9 genotype 4 (8.3%). The median HCV viral load was 868,000 IU/ml (6.15 log10). In this cohort 31 patients (28%) received antiviral therapy for HCV: 2 (1.8%) Interferon (INF) non-pegylated, 3 (2.8%) INF non-pegylated with Ribavirin (RBV) and 25 (23%) INF pegylated with RBV. In 6 cases (19%) were achieved sustained viral response (SVR). In the 25 cases without SVR (81%), 9 (36%) were partial responders, 7 (28%) null responders, 6 (24%) relapsers and 3 (12%) discontinued treatment due to problems of tolerability. In 108 patients were determined the degree of liver fibrosis by transient elastography: 48 patients (44%) had significant fibrosis (F3–F4;>9.5 kpascal) and 30 (28%) liver cirrhosis (F4;>14.5 kpascal). In patients with F4, 5 (17%) had values between 14.5–20 kpascal, 14 (47%) values between 21–40 kpascal and 11 (37%) values over 40 kpascal. Conclusions: In our cohort, the gender predominant was male and the abuse of intravenous drugs was the main cause of HCV transmission. Most patients had genotype 1a, high viral load (>800,000 UI/mL) and a poor rate of SVR (19.3%), predominating the partial response rate among non-responders. A high proportion of patients (28%) had liver cirrhosis (F4), of which, a significant proportion of subjects (37%) were at high risk of hepatic decompensation (>40 kpascal)

Purpose of the study To know the different reasons why we decide not to treat or to delay the antiviral treatment against HCV in HIV coinfected patients. Methods Prospective cohort of HIV and HCV coinfected patients, followed in the Infectious Diseases Department of the Santa Lucia Universitary Hospital (Cartagena, Spain) between 1/12/2011 and 28/02/2012 in which we made transitory elastography. We evaluated the main reasons that moved us to decide not to treat or to delay the antiviral treatment against HCV: social‐familiar‐laboral reasons; neuro‐psychiatric severe diseases; patient decision; low grade hepatic fibrosis; previous failure to pegylated interferon (IFN) and ribavirin (RBV) in no‐1 genotype patients; delay in the approval of the triple therapy with INF‐RBV and a protease inhibitor (boceprevir or telaprevir) by the Regional Sanitary Authority; active alcohol abuse; active diseases that contraindicate the antiviral treatment, incomplete study of HCV (VL of HCV, genotype, ILB28, abdominal ecography); previous intolerance against IFN‐RBV and severe thrombocytopenia (<50×109/L). Summary of results The cohort included 109 patients, being 27 of them females (25%) and 82 males (75%), with a median of age of 45.8 years (SD: 6.2). In 98 patients (90%) we decided not to treat or to delay the antiviral treatment against HCV for one or more of the following reasons: 37 (34%) presented low grade hepatic fibrosis (<9.5 kpascal or F0‐F2); 19 (17%) had neuro‐psychiatric diseases; 18 (16.5%) were waiting for the approval of triple therapy by the Regional Sanitary Authority; 10 (9.2%) did not want to be treated; 10 (9.2%) had failure to IFN‐RBV in no‐1 genotype; 6 (5.5%) had social‐familiar‐laboral reasons; 6 (5.5%) presented active severe diseases; 4 (3.7%) were waiting to complete HCV study; 3 (2.8%) presented active alcohol abuse; 3 (2.8%) had previous intolerance against IFN‐RBV treatment and 2 (2%) had severe thrombocytopenia. Conclusions In our cohort of HIV‐HCV coinfected patients it was decided to delay or not to treat chronic hepatitis C in a significant proportion of subjects. The low grade of hepatic fibrosis measured with transitory elastography was the main reason for delaying the HCV antiviral treatment. The neuro‐psychiatric disease was the main clinical reason to not treat HCV. The delay of the approval of triple therapy treatment by the Regional Sanitary Authority was the most relevant non‐ clinical reason in our prospective study.