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Researchers find HCV treatment uptake declined over time among HIV/HCV coinfection

In the Swiss HIV Cohort Study, researchers found that hepatitis C virus infection treatment uptake over the last 13 years has been low and many patients co-infected with HIV and hepatitis C remained untreated since 2013.

“The Swiss HIV Cohort Study offers an ideal platform to study the natural course of HCV infection and long-term influence of HCV treatments in a nationwide representative population of HIV-infected patients,” the researchers wrote in the Journal of Hepatology. “We aimed to assess the changes in epidemiology, clinical course and therapy of HCV infection between 2001 and 2013 and to characterize the population who remains eligible for the new HCV treatment options by the end of 2013.”

Of 12,401 patients, 17% were positive for HCV RNA (n = 2,107) and 23.8% were seropositive for HCV. Thirty-percent of the HCV RNA-positive patients (n = 636) began therapy with an incidence of 5.8 per 100 person-years (95% CI, 5.3-6.2). Of the patients treated with pegylated interferon and ribavirin, 50% achieved sustained virologic response, which represented 15% of all participants with replicating HCV infection, according to the research. Also, of the 636 treated patients, 11% were treated twice and 2% were treated at least 3 times.

Sixteen-percent of patients who were HCV RNA-positive died (n = 344), of which 59% were due to extrahepatic causes. The mortality rate per 100 person-years was 2.9 (95% CI 2.6-3.2) in co-infected patients not treated for HCV, 1.3 (1-1.8) among patients treated for HCV who did not reach SVR, 0.6 (0.4-1) in patients who achieved SVR and 0.9 (0.8-1) in patients without HCV co-infection.

By the end of 2013, 41.2% of patients who were HCV RNA-positive seen during 2000 and 2013 experienced replicated HCV (n = 869). Among these, 699 were treatment-naive, 110 were nonresponders to treatment and 60 relapsed.

“This is one of the largest, nationwide, community-based HIV cohort studies describing the long-term changes in epidemiology, treatment uptake, efficacy and mortality of HCV co-infection since the availability of HCV treatment,” the researchers wrote.

The researchers concluded: “The long-term assessment of HCV treatment uptake and outcome in this large HIV/HCV co-infected population revealed a low treatment uptake, which did not increase over time. … Our findings underscore the importance of efforts for optimizing care of comorbidities in HIV/HCV–co-infected patients, given that curing HCV alone is not sufficient to achieve mortality rates similar to HIV–mono-infected patients.” – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.