Higher levels of adherence to hepatitis C therapy improve treatment outcomes in people with hepatitis C and HIV

Michael Carter
Published: 03 October 2012

Higher levels of adherence to pegylated interferon and ribavirin are associated with better hepatitis C treatment responses in people with HIV and hepatitis C co-infection, US investigators report in AIDS and Behavior.

Adherence to both anti-hepatitis C drugs fell during the 48 weeks of therapy and methadone use was a risk factor for poorer levels of adherence.

“These results show that adherence to anti-HCV [hepatitis C virus] medication should be a focus of clinical care teams prior to and throughout HCV treatment,” write the authors. “The addition of new direct-acting agents to the existing pegylated interferon and ribavirin regimen will increase the complexity of HCV therapy for HIV/HCV-coinfected patients…identifying suboptimal adherence using pharmacy refill records might allow clinicians to counsel patients to improve their adherence during therapy.”

Many people with HIV also have hepatitis C virus (known as co-infection). Liver disease caused by hepatitis C is now an important cause of serious illness and death in this group. However, antiviral therapy can eradicate hepatitis C infection. Standard treatment consists of pegylated interferon with ribavirin and lasts 48 weeks.

The relationship between the level of adherence and response to hepatitis C therapy in people with co-infection is unclear, and little is known about the risk factors for poor adherence to this treatment. Investigators from the US Department of Veterans Affairs therefore designed a retrospective study involving 333 people with co-infection who started hepatitis C therapy between 2001 and 2006.

Adherence was calculated using pharmacy refill records over twelve-week periods.

Treatment consisted of a once-weekly injection with pegylated interferon and twice-daily oral doses of ribavirin.

The investigators assessed the relationship between the level of adherence to each drug and the chances of achieving an early virological response (EVR; an undetectable hepatitis C viral load twelve weeks after initiating treatment) and a sustained virological response (SVR; eradication of hepatitis C shown by an undetectable viral load 24 weeks after the completion of treatment).

Almost all the participants (98%) were men, 80% were infected with hepatitis C genotypes 1 and 4 (the harder to treat strains of the infection), 44% were African American and a third of the participants had a diagnosis of depression at baseline. Most (90%) were taking HIV therapy.

Mean adherence to pegylated interferon was higher than ribavirin adherence during each twelve-week period. Overall, each twelve-week period saw a 3% decline in adherence to pegylated interferon (from 99 to 88%) and a 4% decline in adherence to ribavirin (from 93 to 78%) (p = 0.04 and p = 0.002 respectively).

Some 6% of the study participants were using methadone and this was associated with lower levels of adherence to both drugs (p = 0.002 and p = 0.04).

“Methadone use might be associated with other factors (e.g. cognitive impairment) that might predispose to decreased adherence or it might be a marker for more severe past narcotic addiction, which may relapse during HCV therapy and result in non-adherence,” suggest the investigators.

An EVR was achieved by 45% of people with genotype 1 or 4 infection.

There was a significant relationship between higher levels of adherence to ribavirin and the chances of achieving an EVR (p = 0.009). There was also a weak association between adherence to pegylated interferon and EVR (p = 0.1).

Just over a quarter (27%) of people with genotype 1 or 4 infection achieved an SVR. Higher levels of adherence to both anti-hepatitis C drugs during the first 36 weeks of therapy were associated with better chances of achieving an SVR.

“These results demonstrate the need to emphasize antiviral adherence throughout the course of HCV therapy,” comment the authors.

“This analysis demonstrated that among HIV/HCV-coinfected patients higher levels of adherence to interferon and ribavirin were associated with higher rates of EVR and SVR,” the researchers conclude, “Future studies should examine additional risk factors for non-adherence and evaluate interventions to maximize adherence to HCV therapy in this population.”


Lo Re V et al. Adherence to hepatitis C virus therapy in HIV/hepatitis C-coinfected patients. AIDS Behav, online edition. DOI 10.1007/s10461-012-0288-9, 2012.  

Tell us why you visited aidsmap today

Could you help us by answering three questions on why you’ve visited aidsmap today?

You can close this questionnaire and come back to it later. Just click on the pink circle.

What prompted you to visit aidsmap today?

What exactly are you looking for? What specific questions do you need answered?

Have you found what you were looking for?


Thank you for your feedback

Thank you very much for taking time to fill in this questionnaire. NAM really values your feedback. It helps make the information we provide better.

If you have any other comments on the content of this website, we would be interested to hear from you. Please email info@nam.org.uk.

Hepatitis information

For more information on hepatitis visit infohep.org.

Infohep is a project we're working on with the World Hepatitis Alliance and the European Liver Patients Association.

Visit infohep.org >
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.