INTEGRATED CARE SERVICES FOR ROMANIAN HIV/HCV CO-INFECTED PATIENTS FROM KEY POPULATIONS – LESSONS LEARNED FROM HEPCARE EUROPE PROJECT EXPERIENCE IN BUCHAREST CLINICAL SITE

Abstract

Background. HepCare Europe was a project co-funded by the European Commission with the scope to create and implement a model of HCV management (screening, linkage to care, treatment) for patients from key populations, through outreaching the community and to offer integrated primary and secondary care services. The aim of this sequential research inside the project was to evaluate the socio-demographic and clinical characteristics of HIV/HCV co-infected patients enrolled in HepCare Europe Project at Bucharest clinical site and to compare them to HCV-mono-infected patients. Methods. Prospective study on patients who tested positive for HCV antibodies (using rapid oral tests), part of them being linked to care at “Dr. Victor Babes” Clinical Hospital Bucharest, Romania (SVB), between April 2016 and April 2019. Socio-demographic and clinical characteristics of patients linked to care were compared according to their HIV status. Statistical analysis was performed using SPSS vs. 20.0. Results. A total of 525 patients were screened for HCV antibodies using rapid oral tests, out of which 230 (43.8%) tested positive. Almost all of them were young males (85.2%) and injecting drug users (IDUs) (92.2%). 168 patients (73.0%) were linked to care, with 41.6% being coinfected with HIV. Liver fibrosis assessment was performed in 82.1% patients, almost a third of them having advanced liver fibrosis (27.5%). Plasma HCV-RNA was performed for half of the patients linked to care and 80.9% were detectable. Directing acting antivirals (DAA) treatment was initiated in 24 patients out of which 22 achieved SVR (sustained virological response) and 2 were non-responders (IDUs with genotype 3 treated with non-pan genotypic regimens). HIV-infection was associated with homelessness (p<0.0001), injecting drug use (p=0.001), NPS (new psychoactive substances) use in combination with opioids (p<0.0001), needle sharing (p<0.0001) and alcohol abuse (p<0.0001). The median CD4 cell count (/µl) and median plasma HIV-RNA (log10copies/ml) were 483 (IQR 290, 646) and 2.74 (IQR 1.27, 4.67), respectively. HCV-RNA was significantly higher in HIV/ HCV co-infected patients (p=0.047). Conclusions. HIV/HCV co-infection was high among patients from key populations. HIV infection was associated with multiple risk factors and higher HCV-RNA. Socio-economic barriers and the lack of pan genotypic DAAs limited the treatment and outcomes in this group. This is the first pilot study on managing patients with HCV from key population in Romania.

Keywords

• hiv/hcv co-infection
• hepcare europe
• key populations
• daa