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

Authors


  • This work was presented in part at the 11th International Congress on Drug Therapy in HIV Infection, Glasgow, UK, November 2012, as an oral presentation (Abstract O243).

Correspondence: Mr Daniel Grint, HIV Epidemiology & Biostatistics Group, Research Department of Infection and Population Health, UCL – Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK. Tel: 020 7794 0500 ext. 34684; fax: 020 7794 1224; e-mail: d.grint@ucl.ac.uk

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.

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