HIV-HCV co-infection: half of patients not treated against hepatitis C

Half of the co-infected with HIV and patients with hepatitis C virus (HCV) are not treated against hepatitis C have not been before, according to a survey of hepatologists practicing in centers supported HIV.

The results of this survey were provided during a press conference aimed at presenting expert recommendations for the management of difficult to treat patients, namely co-infected HIV-HCV non-responders to treatment HCV, patients with fibrosis or cirrhosis and drug users intravenously.

The ProspectH group (prospects and optimization of monitoring, management and treatment of hepatitis C) has indeed met for a year to a year and a half, with the support of the pharmaceutical industry, 27 experts in hepatology , virology, infectious disease and psychiatry. The results of their work were submitted to a national meeting in Nice on 17 and 18 September, which hosted 300 specialists, learned societies and patient associations. Final recommendations have been developed.

It is "practical recommendations, although not official because they are not derived from a consensus conference," warns Professor Patrick Marcellin of Beaujon Hospital in Clichy (Hauts-de-Seine), while stressing the recommendations of the consensus conference in 2002 "remain valid", but that "a lot has changed since" and that "we can not achieve consensus conference every year."

Concerning the management of co-infected patients, Dr. Patrice Cacoub, the Pitié Salpêtrière Hospital in Paris, said data from EuroSIDA, that France treats "pretty good" against its hepatitis C patients HIV-HCV co-infected compared to other European countries, although in absolute terms the figure is only 22%.

To understand why so few co-infected patients are treated against hepatitis C, ProspectH group conducted a survey of 71 hepatologists practicing in centers dedicated to AIDS and who supported 380 co-infected patients for four consecutive weeks in late 2004.

This survey reflects the French position in the management of HIV, since most patients receiving highly active antiretroviral therapy (Haart), which are quite effective in three quarters of cases, says Dr. Cacoub .

In contrast, 54% of patients not currently treated against hepatitis C have not been before. Main reason given by the physician in 53% of cases the treatment is questionable, due to minimal hepatic lesions in 32% of cases of excessive alcohol consumption found in 31% of cases and active addiction 12% of cases.

A "bug" is revealed by the survey: on the one hand, the practitioner reported minimal liver damage in 32% of cases, on the other, less than half of patients had undergone a liver biopsy or a non-invasive test for liver fibrosis, Patrice Cacoub regrets.

Other reasons given in each 30% of cases, the treatment for hepatitis C is not a priority, there are cons-indications to treatment (including psychiatric cons-indications in nearly three-quarters of the cases), the belief the practitioner that there will be a poor compliance. This last reason is related to the reluctance of the patient in 48% of cases and insecurity in 31% of cases.

The specialist noted, however, that among the 92 co-infected patients who received hepatitis C treatment, sustained virological response six months after stopping treatment-ie-healing was achieved in 29% of cases, rate "in real life" joining that obtained in randomized clinical trials.

Patrice Cacoub recommends improving the use of diagnostic tests for liver fibrosis and improve the tolerance of anti-hepatitis C treatment through the choice of anti-HIV, the possible use of erythropoietin (EPO), being given the right to a "mini-trial" and / or antidepressant treatment results.

Finally, he advocates taking a disciplinary charge, with the intervention of infectious disease specialists, hepatologists, internists, psychiatrists and addictologists.