Temporal changes and regional differences in treatment uptake of hepatitis C therapy in EuroSIDA

Abstract

Objectives: All HIV/hepatitis C virus (HCV)-coinfected patients with chronic HCV infection and ≥ F2 fibrosis should be considered for HCV therapy. This study aimed to determine the rate of HCV treatment uptake among coinfected patients in Europe.

Methods: EuroSIDA patients with viraemic HCV infection were included in the study. Poisson regression was used to identify temporal changes and regional differences in HCV treatment uptake.

Results: A total of 1984 patients were included in the study, with a median follow-up time of 168 months [interquartile range (IQR) 121-204 months]. To date, 501 (25.3%) HIV/HCV-coinfected patients have received HCV therapy. Treatment incidence rose from 0.33 [95% confidence interval (CI) 0.16-0.50] per 100 person-years of follow-up (PYFU) in 1998 to 5.93 (95% CI 4.49-7.38) in 2007, falling to 3.78 (95% CI 2.50-5.07) in 2009. After adjustment, CD4 cell count > 350 cells/μL [incidence rate ratio (IRR) 1.33 (95% CI 1.06-1.67) vs. CD4 count 200-350 cells/μL] and ≥F2 liver fibrosis [IRR 1.60 (95% CI 1.14-2.25; P = 0.0065) vs. < F2 fibrosis] were predictors of anti-HCV treatment initiation. However, 22% of patients who remain untreated for HCV, with fibrosis data available, had ≥F2 fibrosis and should have been considered for treatment, while only 36% of treated patients had ≥F2 fibrosis.

Conclusions: Although treatment incidence for HCV has increased, there remain a large proportion of patients indicated for treatment who have yet to be treated.

Keywords: EuroSIDA; HIV/HCV coinfection; PEG-interferon; ribavirin; treatment completion.

Figure 1

Temporal change in the incidence of uptake of hepatitis C virus (HCV) treatment. The incidence rate ratio (IRR) was calculated from univariable Poisson regression. CI, confidence interval; PYFU, person-years of follow-up.

Figure 2

Percentage of patients completing hepatitis C virus (HCV) therapy and the median length of treatment duration by HCV genotype. A total of 416 of 429 patients (97.0%) treated for HCV infection with known HCV genotype had sufficient follow-up to determine whether they achieved the minimum treatment duration. Completion of therapy was defined as completing at least 80% of the minimum expected treatment duration; 38.4 weeks for genotypes 1 and 4, and 19.2 weeks for genotypes 2 and 3. IQR, interquartile range.