Trends in HCV treatment uptake, efficacy and impact on liver fibrosis in the Swiss HIV Cohort Study. Liver International
Béguelin et al. aimed to assess the impact of new hepatitis C virus (HCV) direct acting agents (DAAs) on treatment uptake and efficacy as well as its repercussion on liver disease burden in the Swiss HIV Cohort Study (SHCS).
The authors defined three analysis periods based on the availability of HCV treatments in Switzerland: first period 01/2009-08/2011 (prior to the availability of DAAs), second period 09/2011-03/2014 (1° generation DAAs), third period 04/2014-12/2015 (2° generation DAAs).
At the beginning of the third period, 876 SHCS participants had a chronic HCV infection of whom 180 (20%) started treatment with a 2° generation DAA. Three quarters of them had advanced liver fibrosis, of whom 80% where cirrhotics. SV12 was achieved in 173/180 (96%) patients. Three patients died and four experienced virological failure. Over the three periods, treatment uptake (4.5/100py, 5.7/100py, 22.4/100py) and efficacy (54%, 70%, 96%) continuously increased. The proportion of cirrhotic patients with replicating HCV infection in the SHCS declined from 25% at the beginning to 12% at the end of the last period.
In conclusion, there was a substantial increase in treatment uptake and efficacy after the approval of interferon-free second-generation DAA treatments. DAAs were well tolerated and highly efficacious, even among HIV/HCV-coinfected patients with advanced liver fibrosis or cirrhosis in the SHCS. The treatment of this population with advanced liver disease was driven by treatment priorities but also by limitations in reimbursement, and resulted in a significant reduction in the number of cirrhotic patients with replicating HCV.
Comment Dr. Dominique Braun and Prof. Huldrych Günthard, SHCS
By 1st October 2017, the Federal Office of Public Health (FOPH) will annul the three years ago fixed limitations in reimbursement of hepatitis C drugs in Switzerland. With it, for the first time all patients can be treated with newest DAAs, regardless of the genotype and the liver fibrosis stage. These are fantastic news and the result of longstanding joint efforts among the community, the Swiss hepatitis strategy, the industry, and the FOPH. We are grateful to all parties who were involved in this process and who made that achievement possible.