[970] ESTIMATION OF THE HCV-HIV CO-INFECTED POPULATION ELEGIBLE FOR ANTI-HEPATITIS C TREATMENT OR LIVER TRANSPLANT IN SPAIN (GESIDA 29/02 STUDY)

2nd International AIDS Society Conference on HIV Pathogenesis and Treatment

Paris, France - July 13 - 16, 2003

[TITLE:] ESTIMATION OF THE HCV-HIV CO-INFECTED POPULATION ELEGIBLE FOR ANTI-HEPATITIS C TREATMENT OR LIVER TRANSPLANT IN SPAIN (GESIDA 29/02 STUDY)

[AUTHOR(S):] S Hernández¹, R Pacheco¹, S Diz², J Diez³, P García⁴, B Mahillo⁵, H Esteban⁵, JR Arribas¹, C Quereda³, R Rubio⁴, F Pulido⁴, L Moreno³, S Moreno³, JJ Vazquez¹, J González-García¹, y Grupo Cooperativo Estudio GESIDA 29/02
¹Unidad VIH H, La Paz; ²H. Ramón y Cajal; ³Med Preventiva H. La Paz; ⁴H. Doce de Octubre; and ⁵AEC GESIDA, Spain

IAS Conf HIV Pathog Treat 2003 Jul 13-16;2nd: Abstract No. 970
Antiviral Therapy 2003; 8(Suppl. 1):S457-S458

[ABSTRACT:] Objective: To determine the prevalence of co-infected patients who are candidates for anti-HCV treatment or for liver transplant in an area of high HIV-HCV co-infection prevalence.

Patients and methods: Design: Cross-sectional study (year 2002) of a 1,506 HIV+ patients multicentre cohort. Patients’ characteristics: Mean age 40±7. 72% males. 50% diagnosed with HIV infection before 1992. 58% IVDA, 22% heterosexual transmission, 18% homosexual transmission. CDC stage A/B/C and 1/2/3: 38/31/31%, 7/36/57%. Median CD4 423 cel/uL. Viraemia <50 copies/ml 49%. Currently on HAART 80%. Anti-HC treatment eligibility criteria: AST >1.5 ULN, serum HCV PCR+, <60 years, no Child-Pugh score B or C, no other contraindications for interferon/ribavirin treatment. Liver transplant eligibility criteria Child-Pugh score B or C, HIV-infection well controlled or susceptible of good control with HAART, CD4 cell count >100 cells/µl, no CDC C stage (exceptions: TB oesophageal candidiasis), no other contraindications for liver transplant.

Results: 39.4% of the 1006 HCV-HIV co-infected patients fulfilled criteria for anti-HC treatment. Alcohol or other drugs abuse were the most common exclusion criteria for patients who otherwise met anti-HC treatment criteria. Anti-HC treatment has been offered to 79% of the patients who met criteria for treatment but only 48% have started treatment. One-third of the anti-HC treated patients needed dosing reductions and 46% finished the planned treatment duration. 70% received treatment with interferon and ribavirin and 30% only interferon. 9.6% (97) of the HIV-HCV coinfected patients met cirrhosis diagnostic criteria (only clinical criteria=73, biopsy-proven 24). Child-Pugh scores A/B/C 67/28/5%. 56% had detectable HIV viraemia. 16 patients (16.5% of the cirrhotic patients, 1.6 % of all the HIV-HCV co-infected, 1.0% of all the HIV+ patients) met liver transplant eligibility criteria.

Conclusions: In Spain, the economic and medical resources necessary to treat chronic hepatitis C in HIV coinfected patient are enormous. Probably due to this reason less than half of the eligible patients have already received treatment. Although currently only 1.6% of the HIV-HCV co-infected patients are eligible for liver transplant this is a substantial population since HIV-HCV coinfection is highly prevalent in Spain.

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