Eliminating HCV co-infection in HIV: A Positive Health Clinic (PHC) Venture. (4th October 2017)

• Record Type: Journal Article
• Authors: Shah, Arpan; Magrini, Cindy; Mezeivtch, Lori; Hsiao, Chiu-Bin
• Is Part Of: Open forum infectious diseases. Volume 4(2017)Supplement 1
• Page Start: S660
• Page End: S660
• Publication Date: 2017-10-04
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofx163.1759
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: HCV/HIV co-infected patients have a higher risk of liver disease progression and mortality despite highly effective ART. Near 100% cure rate for HCV infection can be achieved by current direct-acting agents (DAA) against HCV. Therefore, treatment for all patients with HCV/HIV has been recommended by IDSA/AASLD. Setting: PHC is a Ryan White Care Act funded HIV outpatient clinic providing care for approximately 900 patients in Pittsburgh, PA. Methods: At our clinic, a quality improvement project incorporating treatment algorithms targeting HCV/HIV was established for providers to guide HCV therapy. Results: From January 1, 2014 to April 30, 2017, a total of 71 (12 F 59 M; 35 AA/1 H/35 W; Risk: 38 IVDU/31 MSM) HCV/HIV co-infections were identified (GT1: 57; GT3: 6; GT4: 1) with median age of 52 years (range: 21–73). Among them, 21 had fibrosure scores ≥ 3 and 22 <2. Out of 43 patients, 38 completed DAA (test of cure: 34) and 5 are currently on therapy. Lengths of treatment were 8 weeks (4), 12 weeks (30), 16 weeks (1) and 24 weeks (3). All patients had undetectable HCV viral loads at end of treatment (EOT) and test of cure (TOC) visits. Owing to our clinic staff members' persistent efforts, 5 patients remained adherent to therapy despite having medical events requiring inpatient admission. One patient skipped 7 days of therapy (D22-D28) but still achieved undetectable levels at the EOT and TOC. Among those who had not received DAA (28), 5 died (AIDS:1, Malignancy:2, ESRD:2, Liver disease:1), 3 patients cleared the HCV virus without DAA; 4 Incarcerated; and 3 lost to care. Other barriers to therapy included Fibrosure <2 (preceding 2/1/2017), metastatic cancer, noncompliance and neuropsychiatric illness. Conclusion: With DAAs, HCV co-infection rate at our PHC has decreased from 8% to 1.5%, anticipating further decrease to 0.5%. In our cohort, there were four HCV/HIV with GT1a were successfully treated with 8 weeks' course. This is not currently endorsed by the IDSA/AASLD guidelines for the co-infected population, however. Appropriate DAA HCV/HIV therapy coupled with intensive counseling and monitoring can possibly achieve 100% cure rate and elimination of HCV infection in HIV. Disclosures: C. B. Hsiao, MERCK: Investigator, Research grant; GILEAD: Investigator, Research grant; VIIV: Investigator, Research grant; GILEAD: Scientific Advisor, Consulting fee