Joint working to treat hepatitis C in hard-to-reach patients who are co-infected: a case study example

Lindsay Chalmers1, Sara Lamond2 and Linda Panton3
1Blood Borne Virus Clinical Nurse Specialist, Infectious Diseases Unit, NHS Lothian; 2Blood Borne Virus Clinical Nurse Specialist Team Leader, Infectious Diseases Unit, NHS Lothian; 3Senior Charge Nurse, Infectious Diseases Unit, NHS Lothian, Edinburgh

As a result of shared routes of transmission, at least one quarter of people living with HIV globally are also infected with hepatitis C (HCV) [1] and the rate of co-infection in the UK is estimated to be approximately 9% [2]. Hepatitis C does not have an effect on HIV progression [3], but despite advances in treatment, patients who are co-infected with HIV and HC are still at higher risk of developing liver cirrhosis [4]. In addition to this, the progression of liver fibrosis in co-infected patients is more rapid than in those who are monoinfected [4]. Successful eradication of HCV is believed to reduce the incidence of hepatocellular carcinoma, slow the progress to liver cirrhosis, and decrease liver-disease-related mortality [5]. Because of these independent risk factors, treatment for hepatitis C in co-infected patients should be a priority [6].
In recent years, there have been significant advances in treatment for hepatitis C, including advances in treatments for those who are co-infected with HIV. Treatment was previously pegylated interferon alfa 2a and ribavirin therapy, lasting 48 weeks. Side effects included flu like symptoms, pancytopenia, GI upset, weight loss, alopecia, sleep disturbance, depression and irritability [4]. In addition to this, patients coinfected with HIV and HCV had only a 20–50% success rate [7]. A combination of poor success rates and a myriad of side effects led to a poor uptake of treatment and a high discontinuation rate [4]. Read more…