Background:  The advent of direct-acting antivirals against hepatitis C virus (HCV) has generated a great interest in its treatment. The aim of the study was to evaluate barriers to treatment of HCV infection in a large inner city where >20 providers are caring for HIV patients and 1 was established to treat HCV/HIV co-infection.

Methods: This is a retrospective analysis of HIV cases co-infected with HCV diagnosed between the years of 2000 and 2011 and received >1 year of medical care. Following the Ethics Committee’s approval, the data from an electronic data base were analyzed using standard statistical methods. HCV was diagnosed with serology or virus detection.

Results:  Of a total of 14,291 HIV⁺ patients, only 51% were tested for HCV (n = 7343). Among them, 17.6% tested positive (n = 1293) and 82.4% (n = 6050) tested negative. Of this HIV⁺/HCV⁺ population (n = 1293), 70% were men and 67% were >50 years old; 62% African American, 25% Hispanic, and 12% white. Only 44% (n = 568) of them were referred to the co-infection clinic. Of the 568 cases referred to the clinic, 59% were genotype (GT) 1A, 23% 1B, 7% GT 2, 4.5% GT 3, and 1% GT 4. Genotype 1A was twice as common as 1B among blacks. There was no statistical difference between genders across the different genotypes. Of patients who were diagnosed with HIV, 50% were tested for HCV at the same time; however, 15% were tested a year later and it took >2 years to test the rest. Among the 1293 who tested positive for HCV only 12% (n = 159) received HCV treatment and of those only 10% achieved a sustained virological response (16 of 159). The treatment success was highest among genotypes 1A and 2.

Conclusions:  These data highlight the great challenges in treating HCV with many providers. Only 51% were tested for HCV and of them only 44% were referred for care. Of the 1293 subjects with HCV⁺/HIV⁺ only 16 achieved a sustained virological response. There is a great need to educate infectious disease providers on HCV treatment for co-infection, as well as a great opportunity to treat the rest in this clinic.