Hepatitis C treatment initiation in HIV-HCV coinfected patients

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Abstract

Background

There are few data regarding HCV treatment initiation among HIV/HCV coinfected patients. The objective of this study was to analyze the changing patterns of HCV coinfection and HCV treatment initiation over time in a large French cohort of HIV/HCV coinfected patients at the beginning of DAA’s era and to analyze factors associated with treatment initiation.

Methods

All HIV/HCV coinfected patients enrolled during 2000–2012 were analyzed. HCV status was defined per calendar year as naïve, spontaneous cure, sustained virological response (SVR), failure or reinfection. HCV treatment initiation rate was determined per year. Trends over time were analyzed using Chi-2 test for trend and linear regression analysis. The effect of covariates on treatment initiation over time was analyzed using generalized estimating equations.

Results

Among 34,308 HIV-infected patients enrolled between 2000 and 2012, 5,562 were HCV coinfected. HCV prevalence declined from 38.4 to 15.1 %. HCV treatment initiation rate fluctuated from 5.6 to 7.4 %/year from 2000 to 2007, dropped to 5.6 % in 2011 and increased to 8.5 % in 2012 due to the use of first-generation DAAs (29.1 % of initiations in 2012). Cumulative HCV treatment initiation rate increased from 14.8 % in 2000 to 54.7 % in 2012. HCV cure rate increased from 12.4 to 45.2 %. Older age, male gender, male homosexuality, high CD4, undetectable HIV-RNA, CDC stage A-B, and severe fibrosis/cirrhosis were associated with a higher treatment initiation rate. The role of HCV genotype 1, CDC stage, fibrosis and recent HCV infection on treatment initiation rate changed over time.

Conclusion

A high rate of HCV treatment initiation was observed at the beginning of DAAs era in HIV/HCV coinfected patients. Given the very high efficacy of new DAA-based regimens and if treatment initiation keeps increasing, HCV prevalence among HIV patients will drastically decrease during the forthcoming years.

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-016-1681-1) contains supplementary material, which is available to authorized users.

Related collections

Most cited references 27

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Is Open Access

EASL Recommendations on Treatment of Hepatitis C 2015.

(2015)

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Epidemiology of viral hepatitis and HIV co-infection.

Miriam J Alter (2006)

Worldwide, hepatitis B virus (HBV) accounts for an estimated 370 million chronic infections, hepatitis C virus (HCV) for an estimated 130 million, and HIV for an estimated 40 million. In HIV-infected persons, an estimated 2-4 million have chronic HBV co-infection and 4-5 million have HCV co-infection. HBV, HCV and HIV share common routes of transmission, but they differ in their prevalence by geographic region and the efficiency by which certain types of exposures transmit them. Among HIV-positive persons studied from Western Europe and the USA, chronic HBV infection has been found in 6-14% overall, including 4-6% of heterosexuals, 9-17% of men who have sex with men (MSM), and 7-10% of injection drug users. HCV infection has been found in 25-30% of HIV-positive persons overall; 72-95% of injection drug users, 1-12% of MSM and 9-27% of heterosexuals. The characteristics of HIV infected persons differ according to the co-infecting hepatitis virus, their epidemiologic patterns may change over time, and surveillance systems are needed to monitor their infection patterns in order to ensure that prevention measures are targeted appropriately.

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Hepatitis C Virus prevalence among patients infected with Human Immunodeficiency Virus: a cross-sectional analysis of the US adult AIDS Clinical Trials Group.

Natasa Rajicic, Susan D. Rouster, K Sherman … (2002)

Hepatitis C virus (HCV) has emerged as an important etiologic agent of liver injury and failure in patients infected with human immunodeficiency virus (HIV). The prevalence and characteristics of HCV in a representative cohort of HIV-infected patients have not been described. Therefore, a representative sample of 1687 HIV-infected patients was studied; a 213-sample subcohort was selected by use of risk-based sampling from 2 large prospective US Adult AIDS Clinical Trials Group clinical trials. HCV prevalence, HCV RNA level, and genotype were determined. The weighted overall estimate of HCV prevalence in the study cohort was 16.1% (95% weighted confidence interval, 14.3%-17.8%), with significant variability depending on risk factors and HIV RNA levels. Among patients defined as being "at risk", 72.7% were HCV positive, whereas, among low-risk patients, the positivity rate was 3.5%. Genotype 1 was found in 83.3% of infected patients. Median HCV RNA level was 6.08x106 IU/mL. High virus loads and genotype 1 prevalence may be important to interferon-based antiviral response rates among coinfected patients.

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Author and article information

Contributors

Laurent Cotte: +33 (0)4 26 73 26 56 , laurent.cotte@chu-lyon.fr

Pascal Pugliese: pugliese.p@chu-nice.fr

Marc-Antoine Valantin: marc-antoine.valantin@psl.aphp.fr

Lise Cuzin: cuzin.l@chu-toulouse.fr

Eric Billaud: eric.billaud@chu-nantes.fr

Claudine Duvivier: claudine.duvivier@pasteur.fr

Alissa Naqvi: naqvi.a@chu-nice.fr

Antoine Cheret: antoinecheret@free.fr

David Rey: david.rey@chru-strasbourg.fr

Pierre Pradat: pierre.pradat@univ-lyon1.fr

Isabelle Poizot-Martin: Isabelle.POIZOT@ap-hm.fr

Journal

Journal ID (nlm-ta): BMC Infect Dis

Journal ID (iso-abbrev): BMC Infect. Dis

Title: BMC Infectious Diseases

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2334

Publication date (Electronic): 22 July 2016

Publication date PMC-release: 22 July 2016

Publication date Collection: 2016

Volume: 16

Electronic Location Identifier: 345

Affiliations

[ ]Department of Infectious Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, INSERM U1052, Lyon, France

[ ]Department of Infectious Diseases, Centre Hospitalier Universitaire de l’Archet, Nice, France

[ ]Department of infectious diseases, Pitié-Salpêtrière Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France

[ ]UMR-S 943, INSERM, Paris, France

[ ]INSERM, UMR 1027, Toulouse, F-31000 France

[ ]Université de Toulouse III, Toulouse, F-31000 France

[ ]CHU Toulouse, COREVIH Toulouse, F-31000 France

[ ]Department of Infectious Diseases, Hotel Dieu Hospital, Nantes, France

[ ]Université Paris Descartes, Sorbonne Paris Cité, EA7327 Paris, France

[ ]Assistance Publique - Hôpitaux de Paris - Hôpital Necker-Enfants malades, Service des Maladies Infectieuses et Tropicales, Centre d’Infectiologie Necker-Pasteur, IHU Imagine, Paris, France

[ ]Department of infectious diseases, Centre Hospitalier de Tourcoing, Tourcoing, France

[ ]Department of Infectious Diseases, Hôpitaux Universitaires, Strasbourg, France

[ ]Center for Clinical Research, Department of Hepatology, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France

[ ]Aix-Marseille University, Assistance Publique – Hôpitaux de Marseille - Hôpital Sainte-Marguerite, Immuno-hematology clinic, 13009 Marseille France, Inserm U912 (SESSTIM), 13009 Marseille, France

[ ]Department of Infectious Diseases and Tropical Medicine, Croix-Rousse Hospital, 103 grande rue de la Croix-Rousse, 69317 Lyon, CEDEX 04 France

Article

Publisher ID: 1681

DOI: 10.1186/s12879-016-1681-1

PMC ID: 4957284

PubMed ID: 27450098

SO-VID: 9b93235a-4471-44c6-a6f1-38bba2573539

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.