Low rates of HCV treatment among eligible injection drug users
Most HCV-positive IDUs do not receive HCV treatment. M Sulkowski and co-workers from Johns Hopkins in the US presented findings from a study to determine the proportion of HIV-positive and HIV-negative IDUs (former and active) in their programme who are eligible for and initiate HCV therapy with pegylated interferon (pegINF) + ribavirin (RBV) in the absence of geographic and financial barriers (treatment was offered free and on-site).
The study enrolled 332 subjects (172 HIV/HCV co-infected; 158 HCV mono-infected). HIV-co-infected IDUs were younger (41 to <44 years) and were more likely to be African American (90% to >74%), have a monthly income >$500 (52% to >23%) than those with HCV alone. The investigators reported no difference in the prevalence of mental illness (~ 64%), alcohol use (~ 20%), or interest in receiving HCV treatment (~ 93%).
HIV-co-infected IDUs were more likely to have detectable HCV RNA (20/172 HIV/HCV co-infected, 11%; 29/143 of HCV mono-infected, 20%; p <0.001) and less likely to be eligible for HCV treatment (75/152 of HIV/HCV, 49%; 78 /114 HCV, 68%; p = 0.002). Reasons given for ineligibility were: severe depression (HIV/HCV 12%; HCV 30%); life expectancy <2 years (HIV/HCV 40%; HCV 30%); hematologic abnormality (HIV/HCV 49%; HCV 22%); renal insufficiency (HIV/HCV 10%; HCV 8%). Of the treatment-eligible IDUs, ~ 40% initiated HCV therapy, defined as at least pegINF injection (31/75 HIV/HCV, 41%; 27/80 HCV, 36%).
The investigators concluded: While ~ 50% of HIV/HCV-co-infected IDUs were ineligible for HCV treatment, most (~ 80%) of HCV-mono-infected IDUs were treatment-eligible. Despite the removal of financial and geographic barriers, only ~ 40% of treatment-eligible IDUs initiated HCV treatment. Strategies are needed to increase HCV treatment uptake among IDUs.
Sulkowski M, S Mehta S, Moore R et al. Low rates of HCV therapy among treatment-eligible injection drug users with and without HIV Co-infection. 14th CROI, 2007, Los Angeles. Poster abstract 947.