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

D Grint, L Peters, C Schwarze-Zander, M Beniowski, C Pradier, M Battegay, D Jevtovic, V Soriano, J D Lundgren, J K Rockstroh, O Kirk, A Mocroft, EuroSIDA in EuroCoord, M Losso, M Kundro, J M Ramos, N Vetter, R Zangerle, I Karpov, A Vassilenko, V M Mitsura, O Suetnov, N Clumeck, S De Wit, M Delforge, E Florence, L Vandekerckhove, V Hadziosmanovic, K Kostov, J Begovac, L Machala, D Jilich, D Sedlacek, J Nielsen, G Kronborg, T Benfield, M Larsen, J Gerstoft, T Katzenstein, A B E Hansen, P Skinhøj, C Pedersen, L Ostergaard, U B Dragsted, L N Nielsen, K Zilmer, J Smidt, M Ristola, C Katlama, J-P Viard, P-M Girard, P Vanhems, C Pradier, F Dabis, D Neau, C Duvivier, J Rockstroh, R Schmidt, J van Lunzen, O Degen, H J Stellbrink, M Bickel, J W Goethe, J Bogner, G Fätkenheuer, J Kosmidis, P Gargalianos, G Xylomenos, J Perdios, H Sambatakou, D Banhegyi, M Gottfredsson, F Mulcahy, I Yust, D Turner, M Burke, S Pollack, G Hassoun, S Maayan, A D'Arminio Monforte, R Esposito, I Mazeu, C Mussini, C Arici, R Pristera, F Mazzotta, A Gabbuti, S Maria Annunziata, V Vullo, M Lichtner, A Chirianni, E Montesarchio, M Gargiulo, G Antonucci, A Testa, G D'Offizi, C Vlassi, M Zaccarelli, A Antorini, A Lazzarin, A Castagna, N Gianotti, M Galli, A Ridolfo, L Sacco, B Rozentale, I Zeltina, S Chaplinskas, T Staub, R Hemmer, P Reiss, V Ormaasen, A Maeland, J Bruun, B Knysz, J Gasiorowski, A Horban, E Bakowska, A Grzeszczuk, R Flisiak, A Boron-Kaczmarska, M Pynka, M Parczewski, M Beniowski, E Mularska, H Trocha, E Jablonowska, E Malolepsza, K Wojcik, F Antunes, M Doroana, L Caldeira, K Mansinho, F Maltez, D Duiculescu, Victor Babes, A Rakhmanova, A Rakhmanova, S Buzunova, I Khromova, E Kuzovatova, D Jevtovic, M Mokráš, D Staneková, J Tomazic, J González-Lahoz, V Soriano, P Labarga, S Moreno, J M Rodriguez, B Clotet, A Jou, R Paredes, C Tural, J Puig, I Bravo, J M Gatell, J M Miró, P Domingo, M Gutierrez, G Mateo, M A Sambeat, J Medrano, A Blaxhult, L Flamholc, A Thalme, A Sonnerborg, B Ledergerber, R Weber, P Francioli, M Cavassini, B Hirschel, E Boffi, H Furrer, M Battegay, L Elzi, P Vernazza, E Kravchenko, N Chentsova, V Frolov, G Kutsyna, S Servitskiy, A Kuznetsova, G Kyselyova, B Gazzard, A M Johnson, D Mercey, A Phillips, M A Johnson, A Mocroft, C Orkin, J Weber, G Scullard, M Fisher, C Leen, J Gatell, B Gazzard, A Horban, I Karpov, B Ledergerber, M Losso, A D'Arminio Monforte, C Pedersen, A Rakhmanova, J Lundgren, A Phillips, P Reiss, M Ristola, J Rockstroh, S De Wit, O Kirk, A Mocroft, A Cozzi-Lepri, D Grint, A Schultze, L Shepherd, D Raben, D Podlekareva, J Kjær, L Peters, J Nielsen, J Tverland, A H Fischer, D Grint, L Peters, C Schwarze-Zander, M Beniowski, C Pradier, M Battegay, D Jevtovic, V Soriano, J D Lundgren, J K Rockstroh, O Kirk, A Mocroft, EuroSIDA in EuroCoord, M Losso, M Kundro, J M Ramos, N Vetter, R Zangerle, I Karpov, A Vassilenko, V M Mitsura, O Suetnov, N Clumeck, S De Wit, M Delforge, E Florence, L Vandekerckhove, V Hadziosmanovic, K Kostov, J Begovac, L Machala, D Jilich, D Sedlacek, J Nielsen, G Kronborg, T Benfield, M Larsen, J Gerstoft, T Katzenstein, A B E Hansen, P Skinhøj, C Pedersen, L Ostergaard, U B Dragsted, L N Nielsen, K Zilmer, J Smidt, M Ristola, C Katlama, J-P Viard, P-M Girard, P Vanhems, C Pradier, F Dabis, D Neau, C Duvivier, J Rockstroh, R Schmidt, J van Lunzen, O Degen, H J Stellbrink, M Bickel, J W Goethe, J Bogner, G Fätkenheuer, J Kosmidis, P Gargalianos, G Xylomenos, J Perdios, H Sambatakou, D Banhegyi, M Gottfredsson, F Mulcahy, I Yust, D Turner, M Burke, S Pollack, G Hassoun, S Maayan, A D'Arminio Monforte, R Esposito, I Mazeu, C Mussini, C Arici, R Pristera, F Mazzotta, A Gabbuti, S Maria Annunziata, V Vullo, M Lichtner, A Chirianni, E Montesarchio, M Gargiulo, G Antonucci, A Testa, G D'Offizi, C Vlassi, M Zaccarelli, A Antorini, A Lazzarin, A Castagna, N Gianotti, M Galli, A Ridolfo, L Sacco, B Rozentale, I Zeltina, S Chaplinskas, T Staub, R Hemmer, P Reiss, V Ormaasen, A Maeland, J Bruun, B Knysz, J Gasiorowski, A Horban, E Bakowska, A Grzeszczuk, R Flisiak, A Boron-Kaczmarska, M Pynka, M Parczewski, M Beniowski, E Mularska, H Trocha, E Jablonowska, E Malolepsza, K Wojcik, F Antunes, M Doroana, L Caldeira, K Mansinho, F Maltez, D Duiculescu, Victor Babes, A Rakhmanova, A Rakhmanova, S Buzunova, I Khromova, E Kuzovatova, D Jevtovic, M Mokráš, D Staneková, J Tomazic, J González-Lahoz, V Soriano, P Labarga, S Moreno, J M Rodriguez, B Clotet, A Jou, R Paredes, C Tural, J Puig, I Bravo, J M Gatell, J M Miró, P Domingo, M Gutierrez, G Mateo, M A Sambeat, J Medrano, A Blaxhult, L Flamholc, A Thalme, A Sonnerborg, B Ledergerber, R Weber, P Francioli, M Cavassini, B Hirschel, E Boffi, H Furrer, M Battegay, L Elzi, P Vernazza, E Kravchenko, N Chentsova, V Frolov, G Kutsyna, S Servitskiy, A Kuznetsova, G Kyselyova, B Gazzard, A M Johnson, D Mercey, A Phillips, M A Johnson, A Mocroft, C Orkin, J Weber, G Scullard, M Fisher, C Leen, J Gatell, B Gazzard, A Horban, I Karpov, B Ledergerber, M Losso, A D'Arminio Monforte, C Pedersen, A Rakhmanova, J Lundgren, A Phillips, P Reiss, M Ristola, J Rockstroh, S De Wit, O Kirk, A Mocroft, A Cozzi-Lepri, D Grint, A Schultze, L Shepherd, D Raben, D Podlekareva, J Kjær, L Peters, J Nielsen, J Tverland, A H Fischer

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.

© 2013 British HIV Association.

Figures

Figure 1
Figure 1
Temporal change in the incidence of uptake of hepatitis C virus (HCV) treatment. The incidence rate ratio (IRR) was calculated from univariable Poisson regression. CI, confidence interval; PYFU, person-years of follow-up.
Figure 2
Figure 2
Percentage of patients completing hepatitis C virus (HCV) therapy and the median length of treatment duration by HCV genotype. A total of 416 of 429 patients (97.0%) treated for HCV infection with known HCV genotype had sufficient follow-up to determine whether they achieved the minimum treatment duration. Completion of therapy was defined as completing at least 80% of the minimum expected treatment duration; 38.4 weeks for genotypes 1 and 4, and 19.2 weeks for genotypes 2 and 3. IQR, interquartile range.

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