Theme: Clinical Research Year: 2015
People who inject drugs (PWID), are over-represented among HIV-infected adults co-infected with HCV. Recent data suggest that HCV treatment regimens are equally effective in the setting of HIV co-infection. However, the feasibility (and success rates) of therapy have not been clearly established in co-infected PWID populations. The aim of this study was to evaluate the success of HCV treatment in PWID.
We have established a multi-disciplinary program to recruit and retain HCV-infected PWID in care. The program includes facilitated access to specialty medical care, access to support services. We have conducted a retrospective analysis of all HIV co-infected patients treated for HCV infection. This analysis correlates the likelihood of achieving SVR with a range of baseline demographic and Clinical Research variables, including housing and active drug use.
Of 512 HIV-infected individuals, 245 (47.8%) were co-infected with HCV. Among the latter, 172 (70.2%) were PWID. In total, 77 (31.4%) have completed HCV treatment (72 interferon-based, 5 all-oral regimens), and 34 (44.2%) with genotype 1 infection. The mean age of treated patients was 51, 50 (64.9%) were male, 21 (38.9%) were on opiate substitution, 51 (94.4%) were on HIV treatment (46/51 with full virologic suppression), 18 (33.3%) were homeless, and 30 (55.6%) attended weekly HCV support groups. The SVR rate was 53.5% (23/43), 41.2% (14/34) with genotype 1 infection. Success rates were no higher in subjects on methadone 12/21 (57.1%), and no lower in those who were homeless 9/18 (50.0%) or active PWID 10/20 (50.0%).
PWID with HIV co-infection can be successfully treated for HCV infection within multi-disciplinary programs. Our program will serve as an important tool to address the HCV Epidemiology & Public Health Researchdemics in vulnerable populations often considered as “core transmitters” of HCV and HIV infections, with SVR rates >90% expected as all-oral regimens become the standard of care.