Barriers to hepatitis C treatment in HIV/HCV-coinfected patients in an HIV reference center in Argentina

EUGENIA SOCIAS; NATALIA LAUFER; MERCEDES CABRINI; ANDREA DUARTE; MARÍA JOSÉ ROLÓN; GUILLERMO SUAYA; ANA MARTÍNEZ; HÉCTOR PÉREZ; PEDRO CAHN

México DF, México

Conferencia; AIDS 2008 - XVII International AIDS Conference; 2008

IAS

Background: With more effective management of HIV, HCV has become a growing cause of morbidity and mortality among HIV-infected patients, yet HCV treatment rates remains low. Objectives: to describe the HIV/HCV-coinfected population referred for HCV care, to determine the proportion of them eligible for HCV therapy and to identify barriers to HCV treatment in an HIV reference center in Argentina. Methods: In a center with more than 2500 HIV-infected patients on follow-up, 21.7% HCV-coinfected (as previously reported), a retrospective analysis including patients referred for HCV treatment between May 2006 and December 2007 was performed. Medical records were reviewed: patient demographics, clinical and laboratory parameters, and eligibility for HCV treatment were recorded. Results: 84 HIV/HCV-coinfected patients were referred. Median age: 40 years (r: 27-66); males 68%; IDU 69%, heterosexual contact 26%, MSM 5%; CDC Stage C: 3%;76% on HAART; 85% LT-CD4 >200 cells/mm3. HBsAg positive: 13%. ALT >40 U/l: 85%. Genotype: G1 53%. Liver biopsy (Metavir score): F0-F1 19%, ³ F2 19%, not available 62%. Eleven patients did not complete medical evaluation. Of the remaining 73, 39 (53%) were considered ineligible because of: undetectable HCV RNA (5), endstage liver disease (11), advanced AIDS (6), ongoing alcohol or drug use (7), noncompliance with medical visits (4), active psychiatric disease (2), other reasons (4). Of the 34 eligible patients, 33 initiated treatment, representing 39% of the 84 referred patients. Conclusions: Despite HCV therapy is provided for free as part of the Argentinian HIV programme since 2006, less than 20% of the approximately 500 coinfected patients of our center were referred for HCV care, and only 33 initiated treatment. Physician education for earlier referral, before development of severe liver disease, as well as patient counseling on substance abuse and medical adherence is required. Multidisciplinary approach is needed to overcome barriers to HCV therapy in this population.