Introduction One in eight people living with HIV (PLHIV) in Australia are estimated to be co-infected with Hepatitis C (HCV). In the light of clinical guideline changes with regard to antiretroviral therapy (ART) initiation, we examine the impact of co-infection status on uptake of treatment, and highlight population-specific differences relative to HIV mono-infected patients.
Methods Ipsos Healthcare’s HIV Therapy Monitor is a patient chart audit study, which monitors trends in the treatment of PLHIV in Australia. Demographic and treatment data are collected bi-annually from a panel of 25+ HIV-treating clinicians. The data in this report is based on a sample of 4331 patient records collected between 2008- 2014, of which 412 were co-infected with HCV.
Results While the proportion of HIV mono-infected patients receiving ART has steadily increased from 67% in 2008 to 84% in 2014 (p < 0.0001), the opposite trend is observed in the HIV/HCV co-infected population. The rate of treatment in the co-infected cohort has dropped from 84% in 2010/2011 to 66% in 2014 (p = 0.003), with co-infected patients experiencing an average delay of 42 months between HIV diagnosis and initiation of ART, compared with 25 months for mono-infected patients (p = 0.013). Patient’s lack of support network was most frequently cited by clinicians as the reason for delaying treatment for co-infected patients, followed by patient choice and expected non-compliance.
Conclusion Increasing evidence is now available to support early initiation of ART, both in terms of clinical benefits as well as in preventing disease transmission. However, despite encouraging results among HIV mono-infected patients, outcomes for the HIV/HCV co-infected population reveal a growing disparity between these groups in Australia. The increasing delay to treatment supports the need to consider this patient group a priority population, and indicates that further action is required to address the complications involved in treating these patients.
Disclosure of interest statement There are no conflicts of interest to declare.
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