HIV-HCV co-infection: we must improve access to treatment

We must improve access to treatment for co-infected with HIV and patients with hepatitis C (HCV), according to preliminary findings of the jury of the first European Consensus Conference on the treatment of these patients, who s is held in Paris.
Insufficient to overcome
The jury of this consensus conference published its preliminary findings before a small audience of members of associations of patients and specialists, who were able to ask questions and make comments. The final recommendations, which take into account the last debate were published in the "Journal of Hepatology".

More than a quarter of people with HIV are infected with HCV, and nearly 10% are HBV, said the press release on the occasion of the presentation of the preliminary recommendations. "The extension of the life of people infected with HIV has given rise to the forefront the problem of hepatitis diseases relatively slow evolution", making cirrhosis and liver cancer due to hepatitis C because the first mortality of patients with AIDS, said the document.

However, only "5 to 25% of co-infected patients are treated in Europe. Should at least double these figures. Should bring patients to make poor prognostic factors treated up unless they have ", told Reuters Health Dr. Dominique Salmon, the Cochin Hospital in Paris (XIV, AP-HP), who co-chaired the organizing committee for the consensus conference.

Access to HCV treatment is particularly necessary in those most affected by co-infection and constitute a reservoir of transmission, namely drug, including adds Dr Nathan Clumeck, CHU Saint- Pierre in Brussels, who co-chaired the jury of the consensus conference, stressing that there are disparities in care of these patients across Europe.

Drug and alcohol treatment must benefit
The jury considers "ideal offer them out of addiction through programs" replacement therapy. But if these patients' stay in the drug, it should not be excluded from treatment. "

However, treatment should "not be automatic" because it is expensive and requires good compliance and good monitoring. This is why patients remaining in addiction and determined to be treated must be a "medico-psycho-social multidisciplinary management."

The response to treatment among addicts is "the same" as in the general population, "if treatment is followed at the right dose," said Dr. Nathan Clumeck.

Access to treatment should also not be hindered in alcoholics or in case of psychiatric problems. In the latter case, it is necessary to "be attentive to signs of" mental "even discrete", knowing that the treatment "may cause depression or wake up."

Further research
The jury recommended the establishment of studies evaluating new anti-HCV therapy in co-infected, because "we can not be satisfied with 20 to 60% cure rate achieved with the available treatments" ', notes Professor Nathan Clumeck.

Research should also continue on HCV treatments already available, consider European experts. The goal: to identify the effectiveness of different treatment regimens, as well as the interest of maintenance treatment with low dose treatment failure.

An important issue addressed by European experts was also determined by what treatment start, the anti-HIV and anti-HCV therapy treatment, added Dr. Nathan Clumeck. "If immunity is good, that is to say, if the CD4 count is below 500, it is the first anti-HCV treatment" must be undertaken. "If immunity is low, this is the first anti-HIV treatment to increase the level of immunity and after HCV therapy."

Finally, on liver biopsy, the jury said that "it is not imperative" to be used in medical practice for a city anti-HCV treatment started.

Before starting HCV treatment, biopsy is not mandatory for genotypes 2 and 3. However, in case of genotype 1 or potential adverse effects, the biopsy can be used as a "convincing argument" patients to be treated.

On approaches to non-invasive measures of fibrosis that are alternatives to biopsy and were evaluated in single-HCV infection, they should be validated in populations co-infected, says Dr. Nathan Clumeck.