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PLoS One. 2017 May 17;12(5):e0177402. doi: 10.1371/journal.pone.0177402. eCollection 2017.

Access and response to direct antiviral agents (DAA) in HIV-HCV co-infected patients in Italy: Data from the Icona cohort.

Author information

1
Clinic of Infectious and Tropical Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy.
2
Department of Infection and Population Health, Division of Population Health, UCL Medical School, Royal Free Campus, London, United Kingdom.
3
Department of Experimental Medicine and Surgery, University of Rome-Tor Vergata, Rome, Italy.
4
UOC of Infectious Diseases, Dipartimento di Biotecnologie Mediche, University of Siena, Siena, Italy.
5
UOC of Infectious Diseases, Policlinico di Bari, Bari, Italy.
6
Department of Infectious Diseases, San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milan, Italy.
7
Infectious Disease Clinic, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy.
8
Institute of Clinical Infectious Diseases, Department of Public Health, Catholic University of Sacred Hearth, Rome, Italy.
9
Icona Foundation, Milan, Italy.
10
Division of Infectious Diseases, ASST Monza-Brianza- San Gerardo Hospital, University Milano-Bicocca, Monza, Italy.
11
Department of Epidemiology, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy.
12
Clinical Infectious Diseases, Department of Systems Medicine, University of Rome-Tor Vergata, Rome, Italy.
13
HIV/AIDS Department, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy.
14
Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.

Abstract

BACKGROUND:

Real-life data on access and response to direct antiviral agents (DAA) in HIV-HCV coinfected individuals are lacking.

METHODS:

HCV viremic, HIV-positive patients from Icona and Hepaicona cohorts naïve to DAA by January 2013 were included. Access and predictors of starting DAA were evaluated. Switches of antiretroviral drugs at starting DAA were described. We calculated sustained virological response (SVR12) in those reaching 12 weeks after end-of-treatment (EOT), and defined treatment failure (TF) as discontinuation of DAA before EOT or non-SVR12. Statistical analyses included Kaplan-Meier curves, univariable and multivariable analyses evaluating predictors of access to DAA and of treatment outcome (non-SVR and TF).

RESULTS:

2,607 patients included. During a median follow-up of 38 (IQR:30-41) months, 920 (35.3%) patients started DAA. Eligibility for reimbursement was the strongest predictor to access to treatment: 761/1,090 (69.8%) eligible and 159/1,517 (10.5%) non-eligible to DAA reimbursement. Older age, HIV-RNA≤50 copies/mL were associated to faster DAA initiation, higher CD4 count and HCV-genotype 3 with delayed DAA initiation in those eligible to DAA reimbursement. Up to 28% of patients (36% of those on ritonavir-boosted protease inhibitors, PI/r) underwent antiretroviral (ART) modification at DAA initiation. 545/595 (91.6%) patients reaching EOT achieved SVR12. Overall, TF occurred in 61/606 patients (10.1%), with 11 discontinuing DAA before EOT. Suboptimal DAA was the only independent predictor of both non-SVR12 (AHR 2.52, 95%CI:1.24-5.12) and TF (AHR: 2.19; 95%CI:1.13-4.22).

CONCLUSIONS:

Only 35.3% had access to HCV treatment. Despite excellent rates of SVR12 rates (91.6%), only 21% (545/2,607) of our HIV-HCV co-infected patients are cured.

PMID:
28520749
PMCID:
PMC5435319
DOI:
10.1371/journal.pone.0177402
[Indexed for MEDLINE]
Free PMC Article

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