High Hepatitis C cure rates among black and non-black HIV-infected adults in an urban center

Abstract

Background

Hepatitis C virus (HCV) cure rates have been similar in patients with and without HIV co-infection; however, in the ION-4 study, black patients treated with ledipasvir/sofosbuvir were significantly less likely to achieve cure (90%) compared to non-black patients (99%). There are limited real world data on the effectiveness of oral direct acting antivirals (DAAs) in predominantly minority HIV/HCV co-infected populations.

Methods

We analyzed HCV treatment outcomes among 255 HCV co-infected patients initiating DAAs between February 2014 and March 2016 in an urban clinic in Baltimore, Maryland. To facilitate adherence, patients received standardized HIV nurse/pharmacist support which included nurse visits and telephone calls.

Results

The median age was 43 years, 88% were black, 73% male, 69% had a history of injection drug use, 45% a history of hazardous alcohol use and 57% a comorbid psychiatric diagnosis. Median CD4 count was 577 (IQR 397-820) cells/mm³; most (97%) were on antiretroviral therapy, had HIV RNA <20 copies/ml (87%) and were infected with HCV genotype 1 (98%). Over 60% had significant fibrosis [FIB4 score 1.45-3.25 (44%) and >3.25 (17%, cirrhosis)] and 30% were HCV treatment experienced. The majority of patients received ledipasvir/sofosbuvir with or without ribavirin (91%) and were treated for 12 weeks. Overall, the sustained virologic response rate was 97% (95% confidence interval [CI] 93-98) and did not vary by race (black, 96% [95% CI 93-98]; Non-black 97%, [95% CI 83-99]), history of injection drug use, alcohol use or psychiatric diagnosis.

Conclusion

HCV treatment was highly effective among HIV-infected patients who received care within an integrated nurse/pharmacist adherence support program. These results suggest that race and psychosocial comorbidity may not be barriers to HCV elimination. This article is protected by copyright. All rights reserved.

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