Paper
Friday, July 15, 2005
This presentation is part of : Advances in HIV/AIDS Care
Drug Therapy Response Rates in HIV/HCV Co-Infected Patients
Renee Pozza, RN, MSN, CNS, CFNP1, Anna Hefner, RN, MSN, PNP2, Karel Biando3, and Tarek Hassanein, MD, FACP, FACG3. (1) School of Nursing, Southern California Liver Centers and Azusa Pacific University, Riverside, CA, USA, (2) School of Nursing, Azusa Pacific University, Azusa, CA, USA, (3) Hepatology, Southern California Liver Centers, Riverside, CA, USA
Learning Objective #1: Describe treatment outcomes for the HIV/HCV co-infected patient
Learning Objective #2: Identify significant issues related to the treatment of the hepatitis C virus in this patient population
Background: Hepatitis C viral infection (HCV) occurs in approximately 30-40% of HIV-infected patients. End stage liver disease is the leading cause of mortality in the HIV population. Drug therapy for treatment of HCV in co-infected patients is essential to prevent liver decompensation and/or failure. Treatment of HCV in co-infected patients is challenging due to the complexity of combined therapy, yet there is limited research focused on outcomes in this population.

Purpose: Due to complexity issues in management of co-infected patients, this study determined drug therapy response rates.

Methods: 114 HCV/HIV patients were referred for evaluation and potential treatment of HCV. As part of their HCV evaluation workup, patients underwent serum chemistry testing, HIV and HCV viral titer, CD4 count and HCV genotype testing. 79 patients had liver biopsy for grading and staging the severity of liver disease. 83% were on anti-retroviral therapy. 94 patients received standard of care drug therapy for HCV.

Results: 82% were male. Mean age was 44.5 years(22-62). 70% were HCV genotype 1. 59% had undetectable HIV level by PCR. Mean CD4 count was 466. 37% had high HCV viral loads. Liver biopsy results showed 21% had mild inflammation, 64% moderate and 15% severe inflammation. 10% of liver biopsies showed stage 4 cirrhosis. Response rates to drug therapy for the patients who completed follow-up: 15% achieved sustained virologic response, 30% were non-responders, 8% were relapsers and 4% were breakthrough relapsers. 10% prematurely discontinued drug due to side effects. 23% are still receiving drug therapy. 10% are lost to follow-up.

Implications: (1) Treatment of HCV in co-infection is feasible; (2) dropout rates due to side effects and nonadherence is significant and (3) SVR rates are marginal. Strategies to reduce side effects, improve adherence to therapy and increase drug therapy response rates are crucial to this patient population.

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