Infectious Diseases and Tropical Medicine (Feb 2021)

HCV eradication in people living with HIV: the final countdown?

  • A. De Vito,
  • N. Geremia,
  • V. Fiore,
  • S. Malnati,
  • E. Princic,
  • C. Fanelli,
  • I. Maida,
  • S. Babudieri,
  • G. Madeddu

DOI
https://doi.org/10.32113/idtm_20212_685
Journal volume & issue
Vol. 7

Abstract

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BACKGROUND: HCV coinfection is present in 15-30% of people with HIV (PWH). This population shows a rapid progression of hepatic fibrosis and high morbidity and mortality. This study aimed to follow PWH with an active HCV infection after 2018 and investigate the critical barriers to eradicating these patients. PATIENTS AND METHODS: We performed a prospective study on PWH with a positive HCV-RNA after 1stJanuary, 2018. The participants' main characteristics at baseline were compared between those treated or not, using Chi-square or Mann-Whitney U test, as appropriate. Furthermore, data about HCV and liver disease were collected. We collected clinical data after 2, 4, 8, 12, 24, and 48 weeks after the DAA started treating PWH. RESULTS: Seventy-three PWH had a detectable HCV-RNA. Of these, 61 (83.6%) were eligible to receive DAA treatment, but only 53 (72.6%) were treated. On 1st September, 2020, 50 (94.3%) reached a sustained virologic response (SVR), and three (5.7%) patients failed the therapy. Two of these have been retreated with sofosbuvir/velpatasvir/voxilaprevir. One of them showed a second failure, whereas the other finished the therapy, and the SVR result is pending. Over these two years of follow-up, three (4.1%) people died. On September 1st, 2020, 20 patients have not been treated. In 8 cases, the treatment has not been started due to the patient's choice. In the other 8 cases, an important psychiatric condition that implicates poor adherence to HIV treatment was present. The other 4 patients were difficult to reach and had poor compliance. CONCLUSIONS: In the last two years, we have treated 53 PWH, meaning that only 8.2% (20 PWH) still have a detectable HCV-RNA. To treat this kind of patient (psychiatric, poorly adherent, and difficult to reach) we need to implement new strategies, such as directly observed treatment with the addiction of centers' tight synergy with home caring staff assistance.

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