Eligibility and Feasibility of the Treatment of Chronic Hepatitis C in a Cohort of Italian HIV-Positive Patients at a Single HIV Reference Center

Abstract

Chronic hepatitis C is frequent and aggressive among HIV-positive patients; evaluation for anti-hepatitis C virus (HCV)-specific therapy is mandatory, but it has many limitations, due to efficacy, tolerability but also applicability. The objective of our retrospective analysis was to evaluate the eligibility and feasibility of anti-HCV therapy in HIV/HCV-coinfected patients followed at the II Department of Infectious Diseases, L. Sacco Hospital, Milan, Italy, from 2000 to March 2010. In our database, 545 HIV/HCV-coinfected patients were present, representing 40% of our whole HIV population, and 421 included in the analysis. One hundred twenty-four patients were excluded because of loss to follow-up (81) or deceased (43). Forty-eight patients spontaneously cleared HCV during follow-up (11%). Ninety-nine patients received anti-HCV therapy (26%), while the majority was excluded for several reasons (mainly concomitant diseases and low CD4(+) cell count). Globally, we found that in at least one third of untreated patients modifiable barriers to treatment were present. The access to therapy was significantly associated with the absence of history of intravenous drug use (p=0.01), a higher CD4(+) cells count at nadir (p=0.01), the presence of more than 6 HAART regimens (p=0.04), higher alanine aminotransferase (ALT) levels (p<0.0001), HCV genotype 2 or 3 (p=0.005). In a multivariate analysis, the same factors remained significantly associated with anti-HCV therapy. In conclusion, the feasibility of anti-HCV therapy in HIV/HCV-coinfected patients, in our highly specialized center, is approximately 26%. Relative contraindications, such as substance abuses, mild and controlled concomitant conditions, and low compliance are common and modifiable in order to reconsider patients as suitable for therapy.

Prevalence of non-HIV cancer risk factors in persons living with HIV/AIDS

“…Sixty-three studies reported HCV infection prevalence [63-65, 69, 72, 73, 75, 77, 79-84, 88, 90, 102-104, 107, 109, 110, 114, 117-119, 123, 127, 133, 140-173]. We calculated sPrev for HCV-exposed, defined in 69% of individual studies as positive by HCV antibody test, and for chronic HCV infection, defined in 80% of studies as positive by HCV antibody and HCV RNA tests (see Supplemental Table S6 for all definitions).…”

Hepatitis C: Understanding factors that influence the physicians' treatment decisions

“…Delgado-Borrego et al, 2010). Angeli et al (2011) focused specifically on patients with chronic HCV and HIV coinfection, to examine the eligibility and feasibility of maintaining antiviral HCV therapy in this group through retrospective analysis. They identified common barriers related to contraindications (e.g.…”

Barriers to care and treatment for patients with chronic viral hepatitis in Europe: a systematic review

“…Overall, 469 studies were identified, of which 454 were captured by the search strategy and 15 by hand searching. The inclusion criteria were fulfilled in 25 studies , from which data were extracted and analysed. The studies flow is shown in Figure .…”

“…Included studies were heterogeneous, with a variety of designs and aims. The vast majority of studies were from Western Europe (22/25 or 88%) , of which six were from France and six from Italy . Two studies were from Eastern Europe and one pan‐European .…”

“…Two studies were from Eastern Europe and one pan‐European . There were eight single centre , 13 multicentre , two regional and two nationwide studies . Four studies reported the results of surveys , of which one was on primary care physicians , two on secondary care physicians and one on patients .…”