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J Hepatol. 2015 Sep;63(3):573-80. doi: 10.1016/j.jhep.2015.04.019. Epub 2015 May 1.

High hepatic and extrahepatic mortality and low treatment uptake in HCV-coinfected persons in the Swiss HIV cohort study between 2001 and 2013.

Author information

1
Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Zurich, University of Zurich, Switzerland. Electronic address: helen.kovari@usz.ch.
2
Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Zurich, University of Zurich, Switzerland.
3
Division of Infectious Diseases, University Hospital, Lausanne, Switzerland.
4
Division of Infectious Diseases, University Hospital, Geneva, Switzerland.
5
Division of Infectious Diseases, Cantonal Hospital, St. Gall, Switzerland.
6
Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Basle, Switzerland.
7
Ospedale Regionale, Lugano, Switzerland.
8
Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Zurich, University of Zurich, Switzerland; Institute of Medical Virology, University of Zurich, Switzerland.
9
University Clinic of Infectious Diseases, University Hospital Berne and University of Berne, Berne, Switzerland.

Abstract

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.

KEYWORDS:

Epidemiology; HCV; HIV; Mortality; Treatment

PMID:
25937433
DOI:
10.1016/j.jhep.2015.04.019
[Indexed for MEDLINE]

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