Abstract
The Netherlands has provided unrestricted access to direct-acting antivirals (DAAs) since November 2015. We analyzed the nationwide hepatitis C virus (HCV) treatment uptake among patients coinfected with human immunodeficiency virus (HIV) and HCV. Methods. Data were obtained from the ATHENA HIV observational cohort in which >98% of HIV-infected patients ever registered since 1998 are included. Patients were included if they ever had 1 positive HCV RNA result, did not have spontaneous clearance, and were known to still be in care. Treatment uptake and outcome were assessed. When patients were treated more than once, data were included from only the most recent treatment episode. Data were updated until February 2017. In addition, each treatment center was queried in April 2017 for a data update on DAA treatment and achieved sustained virological response. Results. Of 23 574 HIV-infected patients ever linked to care, 1471 HCV-coinfected patients (69% men who have sex with men, 15% persons who [formerly] injected drugs, and 15% with another HIV transmission route) fulfilled the inclusion criteria. Of these, 87% (1284 of 1471) had ever initiated HCV treatment between 2000 and 2017, 76% (1124 of 1471) had their HCV infection cured; DAA treatment results were pending in 6% (92 of 1471). Among men who have sex with men, 83% (844 of 1022) had their HCV infection cured, and DAA treatment results were pending in 6% (66 of 1022). Overall, 187 patients had never initiated treatment, DAAs had failed in 14, and a pegylated interferon-alfa-based regimen had failed in 54. Conclusions. Fifteen months after unrestricted DAA availability the majority of HIV/HCV-coinfected patients in the Netherlands have their HCV infection cured (76%) or are awaiting DAA treatment results (6%). This rapid treatment scale-up may contribute to future HCV elimination among these patients.
| Original language | English |
|---|---|
| Pages (from-to) | 1352-1359 |
| Number of pages | 8 |
| Journal | Clinical Infectious Diseases |
| Volume | 66 |
| Issue number | 9 |
| DOIs | |
| Publication status | Published - 1 May 2018 |
Funding
Financial support. A. N. was supported by the “Aidsfonds” Netherlands (grant 2013.037). The AIDS Therapy Evaluation in the Netherlands (ATHENA) database is maintained by Stichting Human Immunodeficiency Virus (HIV) Monitoring and supported by a grant from the Dutch Ministry of Health, Welfare and Sport through the Centre for Infectious Disease Control of the National Institute for Public Health and the Environment. Potential conflicts of interest. J. E. A. has served on advisory boards for Gilead Sciences, Janssen Pharmaceuticals, Bristol-Myers Squibb (BMS), Abbvie, Merck Sharp & Dohme (MSD), and ViiV Healthcare; has been a consultant to ViiV Healthcare; and has received (research) grants from Abbvie, BMS, MSD, and ViiV Healthcare. C. R. has served on advisory boards for BMS, Abbvie, Janssen Pharmaceuticals, and MSD. P. R., through his institution, has received independent scientific grant support from Gilead Sciences, Janssen Pharmaceuticals, Merck, BMS, and ViiV Healthcare, unrelated to the subject of the current study; has served on scientific advisory boards for Gilead Sciences and ViiV Healthcare and a data safety monitoring committee for Janssen Pharmaceuticals; and has chaired a scientific symposium by ViiV Healthcare, for which his institution has received remuneration. B. J. A. R. has received a research grant from MSD (ongoing, 2014–2017), within the context of this article. Outside the context of this article he has received research grants from Gilead Sciences (ongoing, 2013–2017); has been an investigator of trials sponsored by MSD, Gilead Sciences, and Janssen-Cilag; has been an invited speaker for Gilead Sciences, MSD, Pfizer, and Janssen-Cilag; has participated on advisory boards for and received conference invitations from BMS, AbbVie, MSD, Gilead Sciences, and Janssen-Cilag; and has been a consultant to GL Pharmaceuticals. K. B. has served on advisory boards for ViiV Healthcare, BMS, Gilead Sciences, Janssen, and MSD. M. v. d. V., through his institution, has received independent scientific grant support from Gilead Sciences, Janssen Pharmaceuticals, Merck, and ViiV Healthcare; has served on scientific advisory boards for Abbvie, BMS, Gilead Sciences, MSD, and ViiV Healthcare; and has received speaker fees from Gilead Sciences. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
Keywords
- Direct-acting antivirals
- HIV/HCV coinfection
- Treatment uptake
- Coinfection/drug therapy
- Humans
- Middle Aged
- Male
- Treatment Outcome
- HIV Infections/drug therapy
- Netherlands
- Homosexuality, Male
- Health Services Accessibility
- Sexual and Gender Minorities
- Antiviral Agents/therapeutic use
- Adult
- Female
- Hepatitis C, Chronic/drug therapy
- Cohort Studies
