By Hester Phillips

A new study conducted in France reveals that those living with HIV and Hepatitis C co-infection who have a history of homelessness or injecting drug use, are often given less effective HCV medication.

This study is the first to assess the characteristics of people co-infected with HIV/HCV to examine who is being offered direct-acting antivirals (DAA) and who is being offered first-generation HCV treatment, composed of pegylated interferon (PEG-IFN) and ribavirin, which is less effective, takes longer to act and has significantly more side effects. As pharmaceutical companies continue to charge high prices for DAAs, many governments limit access to this medication.

Researchers enrolled 580 people living with HIV/HCV beginning HCV treatment between 2005 and 2016. During the study, health policy in France dictated that people with HCV were assessed for treatment on a case-by-case basis, although in May 2016 the government shifted its position to guarantee universal access to the medication.

Researchers found that, although the majority of people who use drugs received some form of HCV medication, only 40% were given DAA.

Overall, 45% on PEG-IFN had a history of drug use, compared to 30% of people on DAA. Those with a history of injecting drug use were significantly more likely to be given PEG-IFN than DAA, with 69% of people on PEG-IFN having injected drugs, compared to 39% of people on DAA.

Those who regularly used cannabis, something that is linked to relieving both opioid withdrawal symptoms and HIV/HCV-related symptoms, were also more likely to be offered PEG-IFN than DAA (24% versus 16%).

Homelessness and temporary living arrangements were also found to be associated with a lack of access to DAA, with the proportion of people living in unstable housing on PEG-IFN double that of the proportion on DAA (21% compared to 11%).