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. 2023 Apr;8(4):e294-e304.
doi: 10.1016/S2468-2667(23)00056-7.

Reasons for not commencing direct-acting antiviral treatment despite unrestricted access for individuals with HIV and hepatitis C virus: a multinational, prospective cohort study

Cas J Isfordink  1 , Anders Boyd  2 , Rachel Sacks-Davis  3 , Daniela K van Santen  4 , Colette Smit  5 , Marianne Martinello  6 , Mark Stoove  7 , Juan Berenguer  8 , Linda Wittkop  9 , Marina B Klein  10 , Andri Rauch  11 , Dominique Salmon  12 , Karine Lacombe  13 , Ashleigh Stewart  14 , Janke Schinkel  15 , Joseph S Doyle  16 , Margaret Hellard  17 , Marc van der Valk  18 , Gail V Matthews  6 ; InCHEHC study group
Affiliations
Free article

Reasons for not commencing direct-acting antiviral treatment despite unrestricted access for individuals with HIV and hepatitis C virus: a multinational, prospective cohort study

Cas J Isfordink et al. Lancet Public Health. 2023 Apr.
Free article

Abstract

Background: Individuals with HIV and hepatitis C virus (HCV) who remain untreated with direct-acting antivirals can contribute to HCV transmission and HCV-related mortality. We aimed to compare rates of uptake of direct-acting antivirals following unrestricted access to this treatment in high-income countries and examine factors associated with remaining untreated.

Methods: This multinational, prospective cohort study used data from the International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC). We analysed data from nine observational cohorts participating in the InCHEHC, including data from six high-income countries (Australia, Canada, France, the Netherlands, Spain, and Switzerland). We included individuals aged 18 years and older, with HIV and HCV (ie, HCV-RNA positive without evidence of spontaneous clearance) during unrestricted access to interferon-free direct-acting antiviral treatment in each country. We calculated the cumulative proportion of participants who remained untreated with direct-acting antivirals, with follow-up starting after the date of unrestricted access or cohort inclusion, whichever occurred most recently. Factors associated with the commencement rate of direct-acting antiviral treatment were assessed using competing-risks regression with the Fine-Gray method.

Findings: The date of unrestricted access to direct-acting antiviral treatment for people with HIV ranged from Nov 1, 2014, in France to Nov 1, 2017, in Switzerland. We included 4552 individuals with HIV-HCV, mainly men who have sex with men (MSM; n=2156 [47%]) and people who inject or have injected drugs (n=1453 [32%]). 1365 (30%) of 4552 participants remained untreated with direct-acting antivirals. For individuals treated with direct-acting antivirals, median time from start of follow-up to treatment was 5 months (IQR 2-12). For individuals who were not treated with direct-acting antivirals, median follow-up was 22 months (8-30). Being linked to care in Australia, France, or the Netherlands, on antiretroviral therapy, having undetectable HIV RNA, and shorter duration since first positive HCV test were independently associated with higher commencement rate of direct-acting antiviral treatment. Compared with MSM, male heterosexuals and females with unknown or other routes of HIV transmission (ie, neither injection drug use nor heterosexual transmission) had lower rates of commencement.

Interpretation: Despite unrestricted access, almost a third of individuals with HIV-HCV remained untreated with direct-acting antivirals during follow-up, with variation in commencement rate of HCV treatment between countries and key populations. Increased efforts are required to reach the remaining individuals with HIV who are HCV-viraemic to achieve HIV-HCV micro-elimination.

Funding: None.

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Conflict of interest statement

Declaration of interests CJI has received research funding from Gilead, unrelated to this work. MS has received investigator-initiated research funding from Gilead Sciences and AbbVie and consultant fees from Gilead Sciences for activities unrelated to this work. JB has received grants from Gilead, MSD, and ViiV Healthcare; and honoraria for advice or public speaking from Gilead, MSD, Janssen, and ViiV Healthcare. MBK reports grants for investigator-initiated studies from ViiV Healthcare, AbbVie, and Gilead, and consulting fees from ViiV Healthcare, AbbVie, and Gilead, all outside the submitted work. MBK is supported by a Tier I Canada Research Chair. AR reports support to his institution for advisory boards or travel grants from MSD, Gilead Sciences, Pfizer, and AbbVie, and an investigator-initiated trial grant from Gilead Sciences. All remuneration went to his home institution and not to AR personally, and all remuneration was provided outside the submitted work. JS's institution has received research support and consultancy fees from Gilead, and a speaker's fee from Janssen Pharmaceuticals, independent from the submitted work. JSD receives funding from Gilead Sciences and AbbVie, unrelated to this work. MH receives funding from Gilead Sciences and AbbVie unrelated to this work. MvdV reports honoraria or research grants from Gilead, MSD, and ViiV Healthcare, all paid to his institution and outside the submitted work. KL has received research support from MSD unrelated to this work. All other authors report no competing interests.

Comment in

  • The road to hepatitis C virus elimination.
    Cotte L, Pradat P. Cotte L, et al. Lancet Public Health. 2023 Apr;8(4):e254. doi: 10.1016/S2468-2667(23)00052-X. Lancet Public Health. 2023. PMID: 36965979 No abstract available.

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