gms | German Medical Science

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010)

Deutsche Gesellschaft für Infektiologie,
Deutsche AIDS-Gesellschaft,
Deutsche Gesellschaft für Tropenmedizin und Internationale Gesundheit,
Paul-Ehrlich-Gesellschaft für Chemotherapie

23.06. - 26.06.2010, Köln

Evidence for considerable undertreatment of chronic hepatitis C infection in HIV-HCV coinfected patients

Anzeichen für eine deutliche Unterbehandlung einer chronischen Hepatitis C Infektion bei HIV-HCV koinfizierten Patienten

Meeting Abstract

  • A. Baumgarten - Dupke/Carganico/Baumgarten Gemeinschaftspraxis, Berlin, Germany
  • T. Reiberger - Medical University, Dept. of Internal Medicine III, Div. of Gastroenterology & Hepatology, Vienna, Austria
  • B. A. Payer - Medical University, Dept. of Internal Medicine III, Div. of Gastroenterology & Hepatology, Vienna, Austria
  • A. Rieger - Medical University Vienna, Dept. of Dermatology, Div. of Immunology, Allergy & Infectious Diseases, Vienna, Austria
  • M. Peck-Radosavljvic - Medical University, Dept. of Internal Medicine III, Div. of Gastroenterology & Hepatology, Vienna, Austria
  • L. Weitner - Infektionsmedizinisches Centrum Hamburg (ICH), Hamburg, Germany
  • A. Moll - Praxiszentrum Kaiserdamm Moll/Gölz, Berlin, Germany
  • C. Cordes - Praxis Cityost, Berlin, Germany
  • F. Schlote - Praxis Schlote/Lautenroth-Mai/Schuler, Berlin, Germany
  • H.-A. Horst - Universitätsklinik, Kiel, Germany
  • S. Köppe - Praxis Köppe/Kreckel, Berlin, Germany
  • B. Hintsche - Praxis Hintsche/Klausen, Berlin, Germany
  • C. Mayr - Ärzteforum Seestrasse, Berlin, Germany
  • S. Christensen - CIM, Münster, Germany
  • B. Kuhlmann - Praxis Kuhlmann/Holm/Heiken, Berlin, Germany
  • M. Obermeier - Medical Laboratory Berg, Berlin, Germany

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010). Köln, 23.-26.06.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocINF 17-5

DOI: 10.3205/10kit039, URN: urn:nbn:de:0183-10kit0390

Veröffentlicht: 2. Juni 2010

© 2010 Baumgarten et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction: Hepatitis C virus (HCV) coinfection represents a significant factor of mortality and morbidity in HIV patients. According to current guidelines, treatment of chronic HCV infection should be considered as priority in HIV-HCV coinfected patients.

Methods: This multicenter study includes HIV-HCV coinfected patients diagnosed since 2001 in 14 participating centers in Berlin, Hamburg and Vienna. Demographic data including HCV and HIV parameters were recorded. Factors associated with non-initiation of HCV treatment were identified.

Results: 1,033 HIV-HCV patients were included (m/f: 760/273; age: 43±9years; weight: 71±12kg; CD4+ nadir: 255±189/µL; HCV-RNA: 3.79xE6 IU/mL; HIV-RNA: 65xE3 copies/mL). 877 (85%) patients were german/austrian citizens, while 156 (15%) were foreign nationals/immigrants. HCV-genotypes (GT) were predominantly GT-1 (62%) and GT-3 (24%), followed by GT-4 (9%) and GT-2 (5%). Histological data were available for 146 patients with mean METAVIR fibrosis stage 3 (range: 1-4). 416 patients (40%) received HCV treatment, while 617 patients (60%) remained untreated. Main reasons for deferral of HCV treatment were patient wish (20%), adherence/compliance (19%), active IVDU (14%), comorbidities (9%), psychiatric illnesses (9%), advanced immunodeficiency/AIDS (9%), and others/unknown (22%). Patients starting HCV treatment had significantly lower fibrosis stage (F2 vs. F4, p<0.0001), higher actual CD4+ count (530/µL vs. 430/µL, p<0.0001), lower HIV-RNA levels (18E3 vs. 47E3 copies/mL, p=0.0008) and higher ALT (113 vs 75 IU/mL, p< 0.0001) than patients without initiation of HCV treatment. Age, HCV-GT, HCV levels, hemoglobin levels, platelet count and white blood cell count did not significantly affect decision to initiate HCV treatment. Overall sustained virological response (SVR) rate was 51% (155/305), while patients with GT-1 and GT-3 achieved SVR rates of 38% and 75%, respectively.

Conclusion: This large cohort study provides evidence for considerable undertreatment of chronic HCV infection in HIV patients. Despite acceptable treatment success in this real-life setting, HCV remains untreated in the majority of cases and often due to reason that should not be considered as absolute contraindications to antiviral therapy. Established predictors of treatment response, e.g. HCV-GT or HCV load did not influence treatment decision. Strategies to enhance adherence and medical advice for the HIV-HCV coinfected population are urgently needed.

Baumgartner, Obermeier: both authors contributed equally