Simplifying Care: A Real World HCV Treatment Model for Patients with HIV Co-Infection in the DAA Era 838
Introduction: HCV treatment in HIV co-infected (COI) population can be challenging due to prior history of IVDU, opiate dependence, housing disparity and mental health issues. Other barriers to treatment also include cost, access to care as well as interactions between anti-retroviral therapy (ART)...
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| Published in: | The American journal of gastroenterology Vol. 113; no. Supplement; pp. S465 - S467 |
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| Main Authors: | , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
New York
Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
01-10-2018
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Introduction: HCV treatment in HIV co-infected (COI) population can be challenging due to prior history of IVDU, opiate dependence, housing disparity and mental health issues. Other barriers to treatment also include cost, access to care as well as interactions between anti-retroviral therapy (ART) and direct acting antivirals (DAA) agents. We present an algorithm for HCV treatment that is currently being used at our tertiary care HIV clinic. Methods: Positive Health Clinic (PHC) is an urban outpatient clinic for HIV patients. Patients with HIV/HCV-COI are selected to receive treatment based on their genotype using the following algorithm (Figure 1). The treatment algorithm is designed and implemented by a multidisciplinary team. We performed a retrospective chart review of patients referred to PHC for HIV/HCV- COI over a 4 year period. Results: Eighty-six patients with HIV/HCV-COI were identified and 59 of those underwent treatment. Fifty-five patients completed treatment and were cured of HCV. Table 1 outlines outcomes of treatment. Fifty three percent of the patients underwent sustained viral response (SVR) testing after the recommended 12 week period due to inconsistent follow-up. Thirteen patients were excluded from the analysis due to loss to follow-up or disruption in treatment. Conclusion: G/P is cheap and effective across all genotypes, and can be considered the first line for HCV treatment regardless of HIV COI. Potential barrier in treating patients with G/P is drug interactions with ART. Physicians can switch the ART drug or consider using SOF-VEL as an alternative due to fewer interactions. Another challenge faced while managing HCV patients is failure to respond to initial therapy. Current guidelines recommend treatment with Sofosbuvir-Velpatasvir-Voxilaprevir in patients who have failed prior treatment. Based on this we suggest for select groups of patients treatment of HIV/ HCV-COI can be simplified to three drugs: G/P, SOF-VEL and Sofosbuvir-Velpatasvir-Voxilaprevir. Simplifying HIV/HCV - COI treatment can enable primary care physicians to treat these patients which may lead to more widespread access to care and have potential cost saving implications. This could be particularly useful in resource constraint settings. |
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| ISSN: | 0002-9270 1572-0241 |
| DOI: | 10.14309/00000434-201810001-00838 |