Direct acting antiviral (DAA) therapy is a short, safe and effective treatment for chronic hepatitis C virus (HCV). Its high costs led to restricted reimbursement in most countries. Since 11/2015, DAAs can be prescribed to all HIV-HCV co-infected patients in the Netherlands, regardless of the fibrosis stage. We evaluated the impact of unrestricted DAA availability on HCV treatment uptake in HIV-HCV co-infected patients.
The ATHENA cohort collects nationwide data through an opt-out system from 98% of all HIV infected patients in care since 1998, and can provide an overview of HCV treatment uptake and impact over time in this population. Data were collected up until the database lock of 05/2016, i.e. 6 months after unrestricted DAA availability. Patients were included if they ever had 1 positive HCV RNA test, were classified as having a chronic or acute HCV infection, did not spontaneously clear HCV and were still in care (at least 1 clinical visit after 06/01/2015). The presence of severe chronic liver disease (clinical, radiographic or endoscopic signs of severe liver disease, whether or not combined with a histology or FibroScan® result), treatment characteristics and sustained virological response (SVR) were analyzed. When patients were treated more than once, only the most recent treatment and its outcome was included in the analysis.
Of the 22,042 HIV infected patients in the database, 1812 with HCV co-infection were included, of whom 1420 were still in care. Of the 392 patients not retained in care, 63 were lost to follow up, 269 had died and 60 had moved abroad. Of the 1420 still in care, 613 (43%) completed treatment with (PEG)-IFN +/- BOC/TVR, 413 (29%) completed treatment with DAAs, 94 (7%) had not yet completed DAA therapy and 300 (21%) remained untreated (figure). At the time of analysis, 65% (923/1420) of HCV-HIV co-infected patients had either been cured of HCV (n=829) or were completing DAA treatment (n=94). Notably, a high uptake was observed for patients without severe chronic liver disease: only 6 months after unlimited DAA availability, 33% (246/736) of those were cured with DAAs (n=192) or still on DAAs (n=54). The overall SVR after completing DAA treatment was 98% (404/413; 95%CI 96-99%).
Unlimited DAA availability resulted in a rapid treatment uptake among HIV-HCV co-infected patients without severe liver disease in only 6 months. Altogether, 65% of Dutch HIV-HCV co-infected patients are cured or expected to be cured in the near future.