Hepatitis C Virus Micro-Elimination Within a Clinic for People With HIV

Challenges in the Home Stretch

Jaklin Hanna; Jihan Sufian; Jin S. Suh; Humberto R. Jimenez

Disclosures

HIV Medicine. 2022;23(7):801-806. 

In This Article

Abstract and Introduction

Abstract

Objectives: To describe a pharmacist-led campaign aimed at reducing the proportion of people with HIV with ongoing chronic hepatitis C virus (HCV) infection and delineating barriers to HCV care in this patient population.

Methods: An electronic report and retrospective chart review were used to identify patients who remained with HCV infections after a previous treatment initiative. A clinical pharmacist and pharmacy resident approached the remaining HCV patients during their routine visits for HIV care to offer and coordinate direct-acting antiviral (DAA) treatment. The primary end-point was to compare the prevalence of chronic HCV before and after the intervention period. Barriers to care were also evaluated, with logistic regression performed to identify predictors of sustained virologic response (SVR) attainment.

Results: Forty-six patients were included in the analysis (4.2% of clinic population), with HCV prevalence falling to 0.6% (six patients) by the end of the study (p < 0.0001). The HCV care cascade in the cohort was as follows: 70% agreed to and received DAA therapy, 63% initiated therapy, and 50% achieved SVR. The top barriers to care at baseline included recreational drug use (67%), poor engagement in care (61%), and mental health disorders (28%). Poor engagement in care and active recreational drug use were associated with decreased odds of achieving SVR in bivariate analysis.

Conclusions: A coordinated effort can make strides towards reducing the overall burden of HCV in this challenging population. The HCV care cascade remains tied to the HIV continuum of care, with poor engagement in care remaining an important rate-limiting step impeding micro-elimination.

Introduction

The advent of oral direct-acting antivirals (DAAs) has transformed the treatment of chronic hepatitis C virus (HCV) and provides a path towards eradication as a public health threat.[1–3] One strategy to achieve this significant reduction in the consequences of HCV, such as liver cirrhosis and hepatocellular carcinoma (HCC), entails targeting the disease in high-risk subpopulations.[2,3] HCV eradication among people with HIV (PWH) is a promising goal, particularly as screening rates among this community are significantly higher than in the general population.[3,4] Despite significant reductions in morbidity and mortality due to potent antiretroviral therapy (ART), HIV infection remains an independent factor associated with advanced liver disease in patients with HIV/HCV coinfection.[5] Clinical studies have repeatedly demonstrated the exceptional efficacy of DAA-based regimens regardless of HIV diagnosis, in stark contrast to the dismal response rates observed with interferon-based therapy in PWH.[6]

Application of HCV treatment strategies among PWH has been more challenging than anticipated. In addition to overlapping modes of transmission, HCV also shares many of the barriers to care experienced by those living with HIV including recreational drug use and mental health disorders (MHDs), among other factors.[1–9] Despite success in diagnosing and treating chronic HCV during the first few years that DAA-based therapy became available at an inner-city, hospital-based clinic for PWH, a considerable number of patients remained untreated for HCV despite seeking care for HIV and other conditions. A pharmacist-led campaign was performed to reduce the proportion of PWH with ongoing chronic HCV infection and to describe the barriers to care and numerous logistical challenges encountered throughout the HCV care cascade.

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