High Hepatic and Extrahepatic Mortality and Low Treatment Uptake in HCV-coinfected Persons in the Swiss HIV Cohort Study between 2001 and 2013

Kovari, Helen; Ledergerber, Bruno; Cavassini, Matthias; Ambrosioni, Juan; Bregenzer, Andrea; Stöckle, Marcel; Bernasconi, Enos; Kouyos, Roger; Weber, Rainer; Rauch, Andri (2015). High Hepatic and Extrahepatic Mortality and Low Treatment Uptake in HCV-coinfected Persons in the Swiss HIV Cohort Study between 2001 and 2013. Journal of hepatology, 63(3), pp. 573-580. Elsevier 10.1016/j.jhep.2015.04.019

Preview	Text High-Hepatic-and-Extrahepatic-Mortality-and-Low-Treatment-Uptake-in-HCV-coinfected-Persons-in-the-Swiss-HIV-Cohort-Study-between-2001-and-2013_2015_Jo.pdf - Published Version Available under License Creative Commons: Attribution-Noncommercial-No Derivative Works (CC-BY-NC-ND). Download (621kB) | Preview
	Text 1-s2.0-S0168827815003025-main.pdf - Published Version Restricted to registered users only Available under License Publisher holds Copyright. Download (821kB) | Request a copy

BACKGROUND & AIMS

The landscape of HCV treatments is changing dramatically. At the beginning of this new era, we highlight the challenges for HCV-therapy by assessing the long-term epidemiological trends in treatment uptake, efficacy and mortality among HIV/HCV-coinfected people since the availability of HCV therapy.

METHODS

We included all SHCS participants with detectable HCV RNA between 2001 and 2013. To identify predictors for treatment uptake uni- and multivariable Poisson regression models were applied. We further used survival analyses with Kaplan-Meier curves and Cox regression with drop-out as competing risk.

RESULTS

Of 12,401 participants 2107 (17%) were HCV RNA positive. Of those, 636 (30%) started treatment with an incidence of 5.8/100 person years (PY) (95% CI 5.3-6.2). Sustained virological response (SVR) with pegylated interferon/ribavirin was achieved in 50% of treated patients, representing 15% of all participants with replicating HCV infection. 344 of 2107 (16%) HCV RNA positive persons died, 59% from extrahepatic causes. Mortality/100 PY was 2.9 (95% CI 2.6-3.2) in untreated patients, 1.3 (1.0-1.8) in those treated with failure, and 0.6 (0.4-1.0) in patients with SVR. In 2013, 869/2107 (41%) participants remained HCV RNA positive.

CONCLUSIONS

Over the last 13 years HCV treatment uptake was low and by the end of 2013, a large number of persons remain to be treated. Mortality was high, particularly in untreated patients, and mainly due to non-liver related causes. Accordingly, in HIV/HCV-coinfected patients, integrative care including the diagnosis and therapy of somatic and psychiatric disorders is important to achieve mortality rates similar to HIV-monoinfected patients.

Interest & Impact

Downloads

441 since deposited on 12 Jun 2015
45 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item