Treatment of Hepatitis C in HIV Outpatient Study

SUMMARY Only about 1 in 5 HIV/HCV coinfected participants in the HOPS cohort received hepatitis C treatment, though the proportion increased over time.

By Liz Highleyman

Since the advent of effective combination antiretroviral therapy, liver disease due to viral hepatitis has become a leading cause of non-AIDS-related morbidity and mortality among HIV positive people. HIV/HCV coinfected people tend to experience more rapid liver disease progression and do not respond as well to interferon-based therapy as individuals with HCV alone.

In the May 2011 Journal of Viral Hepatitis, C. Vellozzi from the Centers for Disease Control and Prevention (CDC) and colleagues reported results from a study looking at the frequency and predictors of hepatitis C treatment initiation among coinfected participants enrolled in the HIV Outpatient Study (HOPS) during 1999-2007. Participants were followed for an average of about 4 years.

Results

	103 participants, or 20% of HIV/HCV coinfected patients in the HOPS cohort, started hepatitis C treatment during follow-up.
	In a multivariate analysis, black (non-Hispanic) race/ethnicity was independently associated with lower likelihood of starting hepatitis C treatment (hazard ratio [HR] 0.3).
	Having elevated ALT (HR 3.5) and a CD4 T-cell count of at least 500 cells/mm3 (HR 1.8) at study entry independently predicted higher likelihood of treatment.
	An increasing proportion of patients started hepatitis C treatment as time went on.
	5% of patients who started observation during 1999-2001 started treatment during the first year of follow-up, compared with 11% who started during 2002-2004 and 21% who started during 2005-2007.

"Between 1999 and 2007, despite a stable low fraction of patients coinfected with HCV/HIV initiating treatment for HCV infection, an increasing proportion initiated treatment within the first year after the infection was confirmed," the study authors concluded. "Treatment of HCV infection in patients coinfected with HCV/HIV should be considered a priority, given the increased risk of accelerated end-stage liver disease."

Investigator affiliations: Division of HIV/AIDS Prevention, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA; Cerner Corporation, Vienna, VA; Division of Viral Hepatitis, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA; Temple University, Philadelphia, PA.

5/10/11

Reference
C Vellozzi, K Buchacz, R Baker, et al. Treatment of hepatitis C virus (HCV) infection in patients coinfected with HIV in the HIV Outpatient Study (HOPS), 1999-2007. Journal of Viral Hepatitis 18(5):316-324 (abstract). May 2011.