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Coinfected HIV/HCV minorities referred least frequently for hepatitis therapy

BOSTON — Most patients coinfected with hepatitis C virus and HIV were not sent for treatment of their hepatitis infection, with minorities being referred least of all, according to research presented at the 2014 Conference on Retroviruses and Opportunistic Infections.

Researchers at the University of California, San Diego conducted a retrospective cohort analysis of 751 individuals (median age, 43 years, 84% male, 33% non-white, 20% Hispanic) between 2008 and 2012 who were infected with HIV and HCV. Forty percent of patients (n=301) were referred for HCV therapy, and 88 of 281 patients who made at least one visit for treatment evaluation initiated therapy.

Those who were not referred were more likely to be non-white (36% vs. 28%; P=.019) and have a detectable HIV viral load greater than 40 copies/mL (39% vs. 32%; P=.047). Researchers observed no differences in gender distribution, median age or CD4+ count between groups.

Of those patients who started HCV therapy, 22 received triple therapy of pegylated interferon, ribavirin and telaprevir. Across the entire cohort, 41 patients were cleared of HCV.

Among the 193 patients who did not pursue HCV therapy, 43 opted to wait for interferon-free regimens, 33 had decompensated cirrhosis and 16 had a low chance of eradication with available therapies, based on previous treatment failure.

Alcohol and drug use, uncontrolled AIDS, uncompensated neuropsychiatry disease and other ongoing barriers to care were cited in 78 patients who declined therapy, as well as in those not referred for HCV therapy.

“The most frequent reason for not initiating HCV therapy among those assessed is the presence of ongoing barriers to care,” the researchers concluded.

For more information:

Cachay ER. Abstract #672. Presented at 2014 CROI; March 3-6, 2014; Boston.

Disclosure: The researchers report no relevant financial disclosures.