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Observational Study
. 2025 Jul 1;39(8):1074-1079.
doi: 10.1097/QAD.0000000000004161. Epub 2025 Feb 18.

Time to direct-acting antiviral initiation and liver-related events in people with HIV and hepatitis C virus

Mathieu Chalouni  1 , Daniela K Van Santen  1 , Juan Berenguer  2   3 , Inmaculada Jarrin  2 , José M Miro  4 , Marina B Klein  5 , Jim Young  5   6 , Jessie Torgersen  7   8 , Christopher T Rentsch  9   10   11 , M John Gill  12 , Rachel L Epstein  13   14 , Benjamin Linas  13   14 , Robert Zangerle  15 , Bernard Surial  16 , Andri Rauch  16 , Giota Touloumi  17 , Antonios Papadopoulos  18 , Linda Wittkop  19   20   21 , Marc Van Der Valk  22   23 , Anders Boyd  22   23 , Antonella d'Arminio Monforte  19 , Massimo Puoti  24 , Roger W Logan  1 , Sophia M Rein  1 , Miguel A Hernán  1   25 , Sara Lodi  1   26
Affiliations
Observational Study

Time to direct-acting antiviral initiation and liver-related events in people with HIV and hepatitis C virus

Mathieu Chalouni et al. AIDS. .

Abstract

Objective: People with HIV-hepatitis C virus (HCV) co-infection need antiretroviral treatment (ART) to suppress HIV and direct-acting antivirals (DAAs) to cure HCV. ART is typically prioritized, but delays in DAA initiation may increase the risk of liver-related events and HCV transmission to others.

Design: Target trial emulation with observational data collected in routine clinical practice from a collaboration of cohorts from Europe and North America.

Methods: We included DAA-naive adults with HIV-HCV co-infection who achieved HIV virologic suppression (HIV RNA <50 copies/ml) after starting ART between 2013 and 2020. We estimated the probability of not initiating DAAs at 6 and 36 months after HIV virologic suppression and emulated a target trial of early (≤6 months after HIV virological suppression) versus delayed (>6 months) DAA initiation and the 36-month risk of liver-related events (liver decompensation or hepatocellular carcinoma).

Results: Of 862 eligible individuals (median age 46 years; interquartile range 36-56), 14% were women, and 52% had a history of injection drug use. The 6-month and 36-month probabilities of not initiating DAA were 58% [95% confidence interval (CI): 55-61] and 24% (21-27), respectively. The 36-month risk of liver-related events was 1.1% (0.4-2.0) for early initiation and 1.7% (0.7-2.5) for delayed initiation; risk difference -0.5% (-1.2 to 0.4).

Conclusion: Almost one-quarter of people with HIV-HCV co-infection on ART had not initiated DAA 3 years after HIV virologic suppression. Because the 3-year risk of liver-related events was low, estimates of the impact of delayed DAA initiation were imprecise.

Keywords: HIV-virologic suppression; HIV–hepatitis C virus co-infection; direct-acting antivirals; liver-related events; target trial emulation.

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Conflict of interest statement

Conflict of interest disclosure:

MJG has received honoraria as ad hoc member of national HIV advisory boards to Merck, Gilead and ViiVHealth.

JMM has received consulting honoraria and/or research grants from Angelini, Contrafect, Cubist, Genentech, Gilead Sciences, Jansen, Lysovant, Medtronic, MSD, Novartis, Pfizer, and ViiV Healthcare, outside the submitted work.

BS reports financial support for tavel grants from Gilead Sciences and ViiV healthcare, and for advisory boards from Gilead Sciences and MSD, paid to his institution.

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