title: Hepatitis C virus treatment rates and outcomes in HIV/hepatitis C virus co-infected individuals at an urban HIV clinic.
abstract: OBJECTIVE
  The factors associated with hepatitis C virus (HCV) treatment uptake and responses were assessed among HCV/HIV co-infected individuals referred for HCV therapy at an urban HIV clinic.
  
  
  METHODS
  Retrospective review of HIV/HCV patients enrolled in the HCV treatment program at the John Ruedy Immunodeficiency Clinic in Vancouver. The factors associated with treatment uptake were assessed using multivariate analysis.
  
  
  RESULTS
  A total of 134 HCV/HIV co-infected individuals were recalled for assessment for HCV therapy. Overall 64 (48%) initiated treatment, and of those treated 49 (76.6%) attained end treatment response, whereas 35 (57.8%) achieved sustained virological response (SVR). When evaluated by genotype, 53% (17/32) of those with genotype 1, and 65% (20/31) of those with genotype 2 or 3 infections attained SVR. In treated individuals, alanine aminotransferase dropped significantly after treatment (P<0.001). During treatment, CD4 counts dropped significantly (P<0.001) in all patients. The counts recovered to baseline in patients who achieved SVR, but remained lower in patients who failed the therapy (P=0.015). On multivariate analysis, history of injection drug use (odds ratio: 3.48; 95% confidence interval: 1.37-8.79; P=0.009) and low hemoglobin levels (odds ratio: 4.23; 95% confidence interval: 1.36-13.10; P=0.013) were associated with those who did not enter the treatment.
  
  
  CONCLUSIONS
  Only half of treatment-eligible co-infected patients referred for the therapy initiated treatment. Of those referred for the therapy, history of injection drug use was associated with lower rates of treatment uptake. Treated HIV/HCV co-infected individuals benefitted from both decreased alanine aminotransferase (independent of SVR), and rates of SVR similar to those described in HCV monoinfected patients.
authors.affiliation: Department of Medicine, University of British Columbia, Canada. Drmel.murray@gmail.com
authors.forename: Melanie C M
authors.initials: MC
authors.lastname: Murray
authors.forename: Rolando
authors.initials: R
authors.lastname: Barrios
authors.forename: Wendy
authors.initials: W
authors.lastname: Zhang
authors.forename: Mark
authors.initials: M
authors.lastname: Hull
authors.forename: Valentina
authors.initials: V
authors.lastname: Montessori
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hogg
authors.forename: Julio S G
authors.initials: JS
authors.lastname: Montaner
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D018791:CD4 Lymphocyte Count; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000276:immunology / Q000821:virology; D006454:Hemoglobins / Q000378:metabolism; D016174:Hepacivirus / Q000187:drug effects* / Q000276:immunology / Q000302:isolation & purification; D006526:Hepatitis C / Q000188:drug therapy* / Q000453:epidemiology* / Q000276:immunology / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015819:Substance Abuse, Intravenous / Q000453:epidemiology; D016896:Treatment Outcome; D019037:Urban Health Services / Q000706:statistics & numerical data*
chemical_list: D006454:Hemoglobins; D000410:Alanine Transaminase