Evaluation and treatment of hepatitis C in patients with human immunodeficiency virus

The rate of treatment of hepatitis C virus (HCV) infection in human immunodeficiency virus-hepatitis C virus (HIV-HCV) co-infected patients remains historically low. We undertook a retrospective study to review our treatment rate and factors that have negatively influenced this rate. In those treated, we reviewed outcomes and compared results with prior studies.

A total of 233 patients infected with HIV and HCV were followed for 7 years in the infectious diseases (ID) clinic of East Carolina University. Proper follow-up evaluation was determined based on the presence of HCV polymerase chain reaction viral load and genotype testing. The number of patients treated, response to treatment, and reason for no treatment were determined by chart review.

Of 233 patients with positive HCV serology, 48 were excluded due to undetectable HCV viral load. Of the remaining 185 patients, 142 (77%) were evaluated by testing for HCV viral load and genotype, but only 112 of those who were followed up in the clinic regularly were considered eligible for therapy. Fourteen of 112 (12.5%) of patients underwent treatment and only 1 in 14 (7%) attained sustained virological response (SVR). Of the patients tested, 96% had HCV genotype 1, and 81% were African American.

The majority of our HIV-HCV co-infected patients received a proper HCV evaluation, but only 12.5% were offered therapy. Of those treated, only one patient achieved SVR. The higher proportion of genotype 1 and African American patient population are considered the main reasons for the low SVR. Low SVR rate, high rate of adverse effects, and the unique demography of our patient population have been the main reasons for the lower treatment rate.