Research ArticleCare of hepatitis C virus infection in human immunodeficiency virus-infected patients: Modifications in three consecutive large surveys between 2004 and 2009
Introduction
Coinfection with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) is a frequent and particularly serious problem [1], [2], [3], [4], [5], [6]. About 30% of HIV-infected patients in France are also infected with HCV, i.e. close to 30,000 patients [1], [2], [5], [6]. Since the widespread use of combined antiretroviral therapy (cART) was begun, AIDS mortality has progressively decreased, while chronic liver disease, linked primarily to HCV, has become one of the leading causes of morbidity and mortality [2], [4], [6].
Considerable therapeutic progress has been achieved in HCV-infected patients due to combination therapy with pegylated interferon and ribavirin, resulting in a 55–60% sustained virological response (SVR) in HCV mono-infected patients (40–50% in HCV genotype 1, the most frequent HCV genotype worldwide) [7]. Results from large therapeutic trials in HIV–HCV coinfected patients have provided important information. A particularly encouraging result was that the pegylated interferon and ribavirin combination achieved an SVR in 27–44% of coinfected patients [8], [9], [10], [11], resulting in histopathological improvement in most of them. Recent results report similar SVR rates in coinfected more than in HCV mono-infected patients [12], [13], [14], [15]. HCV treatment, however, is given to a small number of HIV–HCV coinfected patients for many reasons, e.g., HCV treatment deemed questionable (minimal hepatic lesions, alcohol abuse, active drug use), lack of available liver biopsy, psychiatric contraindication, and physicians’ conviction of poor patient compliance [16], [17], [18], [19], [20], [21], [22], [23], [24], [25]. Following the First European Consensus Conference on the treatment of chronic hepatitis B and C in HIV-infected patients in 2005, the coinfection guidelines in HIV medicine from the European AIDS Society in 2008 as well as their recent update at the European AIDS Clinical Society conference, it may be assumed that differences in the guidelines may have had an impact on treatment compliance and management standards [26], [27].
The aim of the present study was to analyze the care of HIV–HCV coinfected patients in France in 2009 (including initial workup, mode of treatment, follow-up modalities, and virological response) through a survey and to compare results with surveys conducted in 2004 and 2006 [17], [22].
Section snippets
Patients and methods
The same methodology was used in the three surveys, and details have been published elsewhere [17], [22]. In brief, physicians involved in the management of HIV-infected patients were recruited from 50 specialized centers from all of metropolitan France. These centers were representative of those providing the standard of care in HIV cART in France. Each physician was asked to prospectively fill out a standardized data collection form for all HIV–HCV coinfected patients seen between November 22
Results
Sixty-two, 58, and 71 physicians following HIV–HCV coinfected patients participated in the 2009, 2006, and 2004 studies, respectively (two-thirds of physicians participated in all surveys). The profiles of these physicians did not differ in the three surveys, as they practiced in university hospitals (70–74%), general hospitals (22–25%), or other areas (3–7%). They were from departments of infectious disease (52% vs. 47% vs. 39%, respectively), internal medicine (33% vs. 26% vs. 27%), HIV/AIDS
Discussion
In the last decade, chronic liver disease, linked primarily to HCV, has become one of the leading causes of morbidity and mortality in HIV-infected patients [2], [4], [6]. In the present study we had the opportunity to analyze the care of HIV–HCV coinfected patients in France in 2009 (including initial workup, mode of treatment, follow-up modalities, and virological response) and to compare the results with those obtained in the 2004 and 2006 surveys. We showed that the care of HIV–HCV
Conflicts of interest
All co-authors participated to advisory board meetings sponsored by SCHERING-PLOUGH.
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