Affiliation:
1. Department of Medicine, Owen Clinic
2. Department of Medicine, Division of Infectious Diseases
3. Skaggs School of Pharmacy and Pharmaceutical Sciences
4. Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Diego
Abstract
Abstract
Background. Access to hepatitis C virus (HCV) medications for human immunodeficiency virus (HIV)-infected patients with ongoing barriers to care is restricted by healthcare payers in the absence of HCV treatment outcomes data in the era of direct-acting antivirals (DAA).
Methods. Retrospective analysis of HCV treatment outcomes using interferon (IFN)-free DAA regimens and an inclusive treatment protocol in an urban HIV clinic where ongoing barriers to care (drug or alcohol use, psychiatric disease, and/or unstable housing) are common. Then, using logistic regression analysis, we compared the proportion of HIV-infected patients who achieved HCV sustained viral response (SVR) in the pegylated-IFN plus ribavirin (PEG-IFN/RBV, 2008–2011), pegylated-IFN plus ribavirin and telaprevir (PEG-IFN/RBV/PI, 2011–2013), and IFN-free DAA therapy eras (2014). Results are displayed using forest plots.
Results. The proportion of patients who achieved HCV SVR in the PEG-IFN/RBV, PEG-IFN/RBV/PI, and IFN-free DAA therapy eras increased from 38.4% (95% confidence interval [CI], 23.2–53.7) and 48% (95% CI, 28.4–67.6) to 83.3% (95% CI, 70.0–96.7), respectively. Similar proportions of patients with ongoing barriers to care were treated during the PEG-IFN/RBV (25 of 39 [64%]), PEG-IFN/RBV/PI (14 of 25 [56%]), and IFN-free DAA (16 of 30 [53%]) eras. Hepatitis C virus SVR among patients with ongoing barriers to care improved from 40% (95% CI, 21–59) to 76.5% (95% CI, 56–97) in the PEG-IFN/RBV and IFN-free DAA eras, respectively. After stratification for factors associated with HCV SVR such as HCV genotype and cirrhosis, HCV SVR were similar in patients regardless of the presence of ongoing barriers to care.
Conclusions. Using IFN-free DAA and an inclusive HCV treatment protocol, 76.5% of HIV/HCV-treated patients with ongoing barriers to care achieved HCV SVR.
Funder
Clinical Investigation Core of the University of California San Diego Center
for AIDS Research
CFAR Network of Integrated Clinical Systems
(CNICS)
Pacific AIDS Education and Training Center
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,Oncology
Reference33 articles.
1. Factors associated with specific causes of death amongst HIV-positive individuals in the D:A:D Study;Data Collection on Adverse Events of Anti-HIV Drugs Study Group;AIDS,2010
2. The CORE HCV cascade a decade later: looking ahead to an IFN-free era;Adeyemi,2014
3. The hepatitis C cascade of care among HIV infected patients: a call to address ongoing barriers to care;Cachay;PLoS One,2014
4. Update on HIV/HCV coinfection;Soriano;Curr HIV/AIDS Rep,2013
5. Optimal therapy of HIV/HCV co-infected patients with direct acting antivirals;Rockstroh;Liver Int,2015
Cited by
22 articles.
订阅此论文施引文献
订阅此论文施引文献，注册后可以免费订阅5篇论文的施引文献，订阅后可以查看论文全部施引文献