WOMEN CO-INFECTED WITH HIV AND VHC. PART 2. CLINICAL STATUS AND READINESS TO ANTIVIRAL THERAPY

The materials on psychological and psychosocial status of women with HIV and HCV co-infection [1] with the following assessment of their readiness and ability to undergo treatment of chronic hepatitis C virus and maintenance of treatment compliance to antiretroviral therapy of HIV. The objective of the survey: analysis of the clinical and somatic status of women with HIV and HCV co-infection with the following assessment of their ability to antiviral therapy of CHC and maintenance of treatment compliance to ART taking into account their health status. Materials and methods: the check-up of 100 surveyed women with HIV and HCV co-infection taking into account epidemiologic evidence, laboratory parameters: immunologic (CD4 lymphocyte count), virological (HIV and VHC RNA, VHC genotype) and complete and biochemical blood count was made. Medical prescriptions and response to treatment of CHC were analyzed taking into account the drugs used. Results. Mean age of patients was 36±6 years. Most women had a long-standing co-infection. 1% of women were in the subclinical stage of HIV infection, 64% had stage 4A, 4B — 14% and 4B — 11%. The number of CD4 lymphocytes was 494±29 cells/μl. 78% received ART, and 85% of women showed a high rate of treatment compliance. Among the prevalent HIV-associated diseases were candidiasis (62%), viral (7%) and bacterial diseases (3%); a high percentage (15%) of past tuberculosis of various localization was noted. In 45 cases (53%), HCV RNA was detected in the blood. According to the results of liver elastometry, 74,4% had minimal and moderate fibrosis (METAVIR ≤F2), and a quarter of patients had marked fibrosis (METAVIR F3-F4). Antiviral therapy of chronic hepatitis C was performed in 24% of 100 surveyed women. 62,5% received the combination of pegylated interferon and ribavirin, in 86,6% of cases a sustained virological response was achieved. Treatment with direct antiviral agents was performed in 5 patients, in all cases a sustained virological response was achieved. 85% of patients showed total bilirubin level within the normal range, alanine aminotransferase and aspartate aminotransferase were moderately increased in 41% of women. Most (67,7%) revealed diffuse changes in the structure of the liver, and 36% had pancreatic diffuse changes. Hepatomegaly was found in 24% of cases and splenomegaly was found in 13,3% of women. Comorbid infectious and non-infectious diseases were diagnosed in 59% of women: 32,2% — diseases of the digestive system, 20,3% — diseases of the urogenital system and 18,6% — diseases of the respiratory system. Diseases of the nervous system were diagnosed in 70% of women. Conclusion. The somatic state of women with HIV/HCV co-infection in almost all cases was quite stable, the comorbid pathology was in remission, which gives grounds for expanding indications for prescribing antiviral therapy for CHC. However, many patients are not inclined to undergo treatment with interferon-containing regimens due to the duration of the course and poor tolerance, some of them are focused on treatment with direct-acting antiviral agents and are looking for such a possibility outside the hospital. Therapy with direct-acting antiviral agents with a small number of side effects and high efficacy is a priority for women with HIV/HCV co-infection.