Evaluation of the HIV‐HCV co‐infection status in a cohort of southeastern of Spain

Abstract

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)