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

HIV Med. 2013 Nov;14(10):614-23. doi: 10.1111/hiv.12068. Epub 2013 Jul 19.

Abstract

Objectives: All 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.

Methods: EuroSIDA 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.

Results: A 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.

Conclusions: Although treatment incidence for HCV has increased, there remain a large proportion of patients indicated for treatment who have yet to be treated.

Keywords: EuroSIDA; HIV/HCV coinfection; PEG-interferon; ribavirin; treatment completion.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antiviral Agents / therapeutic use*
  • CD4 Lymphocyte Count / statistics & numerical data
  • Cohort Studies
  • Coinfection
  • Drug Therapy, Combination
  • Europe / epidemiology
  • Female
  • HIV Infections / complications
  • HIV Infections / drug therapy*
  • HIV Infections / virology
  • Hepatitis C, Chronic / complications
  • Hepatitis C, Chronic / drug therapy*
  • Hepatitis C, Chronic / virology
  • Humans
  • Interferon-alpha / therapeutic use
  • Liver Cirrhosis / drug therapy*
  • Liver Cirrhosis / etiology
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care / psychology
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Poisson Distribution
  • Prospective Studies
  • Ribavirin / therapeutic use

Substances

  • Antiviral Agents
  • Interferon-alpha
  • Ribavirin