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Liver Int. 2018 Mar;38(3):424-431. doi: 10.1111/liv.13528. Epub 2017 Aug 23.

Trends in HCV treatment uptake, efficacy and impact on liver fibrosis in the Swiss HIV Cohort Study.

Author information

1
Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland.
2
Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland.
3
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
4
Basel Institute for Clinical Epidemiology & Biostatistics, University Hospital Basel and University of Basel, Basel, Switzerland.
5
Department of Infectious Diseases & Hospital Hygiene, University Hospital Basel and University of Basel, Basel, Switzerland.
6
Division of Infectious Diseases, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland.
7
Division of Infectious Diseases, University Hospital Geneva, University of Geneva, Geneva, Switzerland.
8
Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland.
9
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.

Abstract

BACKGROUND & AIMS:

Hepatitis C virus (HCV) therapies with interferon-free second-generation direct-acting antivirals (DAAs) are highly effective and well tolerated. They have the potential to increase treatment eligibility and efficacy in HIV-infected patients. We assessed the impact of DAAs on treatment uptake and efficacy, as well as its impact on the burden of liver disease in the Swiss HIV Cohort Study (SHCS).

METHODS:

We describe clinical and virological characteristics of patients treated with second-generation DAAs. We compared treatment incidence, sustained virological response (SVR)12 and liver fibrosis stages between three time periods: period 1, 01/2009-08/2011 (prior to the availability of DAAs); period 2, 09/2011-03/2014 (first generation DAAs); period 3, 04/2014-12/2015 (second generation DAAs).

RESULTS:

At the beginning of the third period, 876 SHCS participants had a chronic HCV infection of whom 180 (20%) started treatment with a second-generation DAA. Three-quarters of them had advanced liver fibrosis (Metavir ≥ F3) of whom 80% were cirrhotics. SVR12 was achieved in 173/180 (96%) patients, three patients died and four experienced a virological failure. Over the three time periods, treatment uptake (4.5/100 py, 5.7/100 py, 22.4/100 py) and efficacy (54%, 70%, 96% SVR12) continuously increased. The proportion of cirrhotic patients with replicating HCV infection in the SHCS declined from 25% at the beginning to 12% at the end of the last period.

CONCLUSIONS:

After the introduction of second-generation DAAs, we observed an increase in treatment uptake and efficacy which resulted in a significant reduction in the number of cirrhotic patients with a replicating HCV infection in the SHCS.

KEYWORDS:

DAA ; HCV treatment; fibrosis; long-term trends; uptake and efficacy

PMID:
28741901
DOI:
10.1111/liv.13528

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