In the Journals

Urban clinic achieves high SVR rates in HCV/HIV coinfected patients

Patients with hepatitis C and HIV coinfection had high rates of sustained virologic response in an urban clinical setting with the use of standard nurse and pharmacist adherence support programs, according to results of a recent study.

“In this real-world cohort of predominantly black, inner city HIV/HCV coinfected patients, treated with oral [direct-acting antivirals], we observed high SVR rates (above 95%),” the researchers wrote. “Despite the high prevalence of psychiatric disease and addiction disorders, the observed SVR rate was similar to that observed in registration clinical trials. These HCV cure rates were consistently high regardless of race, cirrhosis status and HCV treatment experience.”

Between February 2014 and March 2016, the researchers analyzed the HCV outcomes of 255 patients who had previously been enrolled in the Johns Hopkins HIV or HIV/HCV clinical cohort studies.

Median patient age was 43 years (range, 38-50 years) and most patients were men (73%) and black (88%). Most patients reported diagnoses of psychiatric disease (57%) and history of illicit drug use (73%).

Most patients were on antiretroviral therapy (97%). Among 179 patients from whom additional behavioral data were available, 89% reporting good to excellent adherence and 86% denying any missed doses. Also in this subgroup, 30% reported active alcohol use, 7% hazardous levels of alcohol, 14% marijuana, 8% cocaine and 6% heroin use.

Of the 255 patients, 246 achieved SVR. All nine patients who failed to achieve SVR had been treated with Harvoni (ledipasvir/sofosbuvir, Gilead). Five of the nine patients experienced virologic relapse, three discontinued treatment prematurely and one patient died of unknown causes at week 3 of treatment.

There were no significant differences between the patients who achieved SVR and those who did not in the categories of race, sex, CD4 cell count, HCV genotype or subtype, cirrhosis status, prior HCV treatment experience, alcohol or hazardous alcohol use, injection drug use or psychiatric comorbid diseases. However, patients with complete HIV suppression were more likely to achieve SVR than those who were not fully suppressed (97.7% vs. 87.9%; P = .01) and patients who switched their antiretroviral therapy prior to HCV treatment had lower rates of SVR compared with those who maintained the same therapy (92.3% vs. 98.3%; P = .02).

“The consistently high rates of SVR in our cohort, regardless of race or other potentially negative predictors of SVR such as a drug or hazardous alcohol use or mental health diagnoses may be related to the unique HCV care model implemented in our clinical practice which is centered on care delivery by the patient’s HIV care nurse with support from an integrated specialty pharmacy,” the researchers concluded. “Patients had routine contact (within the first week of treatment initiation and at least monthly thereafter) with the health care team for the duration of the HCV treatment course; the intensity of this contact was specifically tailored to the individual patient’s need for treatment support. While data on patient adherence was not available, we hypothesize that frequent contact with patients during HCV therapy led to higher rates of DAA adherence, which in turn led to high SVR rates.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.

Patients with hepatitis C and HIV coinfection had high rates of sustained virologic response in an urban clinical setting with the use of standard nurse and pharmacist adherence support programs, according to results of a recent study.

“In this real-world cohort of predominantly black, inner city HIV/HCV coinfected patients, treated with oral [direct-acting antivirals], we observed high SVR rates (above 95%),” the researchers wrote. “Despite the high prevalence of psychiatric disease and addiction disorders, the observed SVR rate was similar to that observed in registration clinical trials. These HCV cure rates were consistently high regardless of race, cirrhosis status and HCV treatment experience.”

Between February 2014 and March 2016, the researchers analyzed the HCV outcomes of 255 patients who had previously been enrolled in the Johns Hopkins HIV or HIV/HCV clinical cohort studies.

Median patient age was 43 years (range, 38-50 years) and most patients were men (73%) and black (88%). Most patients reported diagnoses of psychiatric disease (57%) and history of illicit drug use (73%).

Most patients were on antiretroviral therapy (97%). Among 179 patients from whom additional behavioral data were available, 89% reporting good to excellent adherence and 86% denying any missed doses. Also in this subgroup, 30% reported active alcohol use, 7% hazardous levels of alcohol, 14% marijuana, 8% cocaine and 6% heroin use.

Of the 255 patients, 246 achieved SVR. All nine patients who failed to achieve SVR had been treated with Harvoni (ledipasvir/sofosbuvir, Gilead). Five of the nine patients experienced virologic relapse, three discontinued treatment prematurely and one patient died of unknown causes at week 3 of treatment.

There were no significant differences between the patients who achieved SVR and those who did not in the categories of race, sex, CD4 cell count, HCV genotype or subtype, cirrhosis status, prior HCV treatment experience, alcohol or hazardous alcohol use, injection drug use or psychiatric comorbid diseases. However, patients with complete HIV suppression were more likely to achieve SVR than those who were not fully suppressed (97.7% vs. 87.9%; P = .01) and patients who switched their antiretroviral therapy prior to HCV treatment had lower rates of SVR compared with those who maintained the same therapy (92.3% vs. 98.3%; P = .02).

“The consistently high rates of SVR in our cohort, regardless of race or other potentially negative predictors of SVR such as a drug or hazardous alcohol use or mental health diagnoses may be related to the unique HCV care model implemented in our clinical practice which is centered on care delivery by the patient’s HIV care nurse with support from an integrated specialty pharmacy,” the researchers concluded. “Patients had routine contact (within the first week of treatment initiation and at least monthly thereafter) with the health care team for the duration of the HCV treatment course; the intensity of this contact was specifically tailored to the individual patient’s need for treatment support. While data on patient adherence was not available, we hypothesize that frequent contact with patients during HCV therapy led to higher rates of DAA adherence, which in turn led to high SVR rates.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.