Temporal changes and regional differences in treatment uptake of hepatitis C therapy in EuroSIDA

Abstract

ObjectivesAll HIV/hepatitis C virus (HCV)-coinfected patients with chronic HCV infection and ≥ F2 fibrosis should be considered for HCV therapy. This study aimed to determine the rate of HCV treatment uptake among coinfected patients in Europe.MethodsEuroSIDA patients with viraemic HCV infection were included in the study. Poisson regression was used to identify temporal changes and regional differences in HCV treatment uptake.ResultsA total of 1984 patients were included in the study, with a median follow-up time of 168 months [interquartile range (IQR) 121–204 months]. To date, 501 (25.3%) HIV/HCV-coinfected patients have received HCV therapy. Treatment incidence rose from 0.33 [95% confidence interval (CI) 0.16–0.50] per 100 person-years of follow-up (PYFU) in 1998 to 5.93 (95% CI 4.49–7.38) in 2007, falling to 3.78 (95% CI 2.50–5.07) in 2009. After adjustment, CD4 cell count > 350 cells/μL [incidence rate ratio (IRR) 1.33 (95% CI 1.06–1.67) vs. CD4 count 200−350 cells/μL] and ≥F2 liver fibrosis [IRR 1.60 (95% CI 1.14–2.25; P = 0.0065) vs. < F2 fibrosis] were predictors of anti-HCV treatment initiation. However, 22% of patients who remain untreated for HCV, with fibrosis data available, had ≥F2 fibrosis and should have been considered for treatment, while only 36% of treated patients had ≥F2 fibrosis.ConclusionsAlthough treatment incidence for HCV has increased, there remain a large proportion of patients indicated for treatment who have yet to be treated.

Retrospective study of hepatitis C outcomes and treatment in HIV co-infected persons from the Australian HIV Observational Database

“…Large European cohorts report between 25% and 30% of co-infected patients initiate HCV therapy. 8,9 The majority of US studies report 15% or less. 10 …”

HCV RNA viral load is independent from CD4 cell count and plasma HIV RNA viral load in immunocompetent HIV-HCV co-infected patients: a 3-years follow-up study

“…The study by Ioannou et al [21] reported that only 994 out of 5999 (18%) HIV-HCV-co-infected patients assisted by the Veterans Affairs healthcare system received an interferon-based regimen. This percentage rises to 25.3% in the EuroSIDA cohort but is accompanied by a reduction in treatment incidence in 2009 [22]. The proper timing at which to begin pegylated interferon and ribavirin treatment, associated with DAA when indicated, must take HIV disease status into account, but such coordination is not an easy task.…”

HIV and hepatitis C co-infection in Europe, Israel and Argentina: a EuroSIDA perspective

“…Patients residing in southern Europe have been more likely to receive HCV treatment compared with patients from other EuroSIDA regions. The decrease in recent years is probably explained by treatment saturation of the patients in urgent need of therapy, as well as by patients and physicians waiting for better treatment options [2,7]. Among the proportion of co-infected patients with information on fibrosis available, only one-third of treated patients had significant fibrosis (METAVIR F2 or greater), while 22% of untreated patients had significant fibrosis.…”

“…Among the proportion of co-infected patients with information on fibrosis available, only one-third of treated patients had significant fibrosis (METAVIR F2 or greater), while 22% of untreated patients had significant fibrosis. Hence many patients with minimal short- to intermediate-term risk of HCV-related complications received a costly treatment associated with many adverse effects, while many patients at risk of complications of their HCV infection did not receive relevant treatment [2]. …”