Uptake of HCV treatment in HIV/HCV coinfected patients across europe in the era of direct-acting antivirals. AIDS
Peters et al. the EuroSIDA Study Group aimed to investigate regional differences in the rate of hepatitis C virus (HCV) treatment uptake, and type of therapy used among HIV/HCV-coinfected patients in the pan-European Euro-SIDA study between 2011 and 2016.
Among 4’308 HCV-RNA positive patients with 11’863 person-years of follow-up, 1’113 (25.8%) started any HCV therapy. Among patients with at least F3 fibrosis, more than 50% in all regions remained untreated. The incidence (per 1’000 person-years of follow- up, 95% confidence interval) of starting DAA increased from 7.8 (5.9–9.8) in 2014 to 135.2 (122.0–148.5) in 2015 and 128.9 (113.5–144.3) in 2016.
The increase was highest in North and West and intermediate in South, but remained modest in Central East and Eastern Europe. After adjustment, women, individuals from Central East or East, genotype 3, antiretroviral therapy naïve and those with detectable HIV-RNA were less likely to start direct acting agents (DAA). Older persons, those with HCV-RNA more than 500’000 IU/ml and those with more advanced liver fibrosis were more likely to start DAA.
In conclusion, this study shows that although the use of effective and well tolerated DAAs against HCV have increased markedly among HIV/HCV-coinfected patients in Europe in general since 2014, cost of the drugs and other barriers to treatment prevent them from reaching some of the patients most at need of HCV treatment. Further follow-up to monitor access to DAA therapy to achieve the WHO HCV elimination goal in 2030 among HIV/HCV-coinfected in Europe is warranted.