Background. Access
to hepatitis C virus (HCV) medications for human immunodeficiency virus
(HIV)-infected patients with ongoing barriers to care is restricted by
healthcare payers in the absence of HCV treatment outcomes data in the era of
direct-acting antivirals (DAA).
Methods. Retrospective
analysis of HCV treatment outcomes using interferon (IFN)-free DAA regimens and
an inclusive treatment protocol in an urban HIV clinic where ongoing barriers
to care (drug or alcohol use, psychiatric disease, and/or unstable housing) are
common. Then, using logistic regression analysis, we compared the proportion of
HIV-infected patients who achieved HCV sustained viral response (SVR) in the
pegylated-IFN plus ribavirin (PEG-IFN/RBV, 2008–2011), pegylated-IFN plus
ribavirin and telaprevir (PEG-IFN/RBV/PI, 2011–2013), and IFN-free DAA therapy
eras (2014). Results are displayed using forest plots.
Results. The
proportion of patients who achieved HCV SVR in the PEG-IFN/RBV, PEG-IFN/RBV/PI,
and IFN-free DAA therapy eras increased from 38.4% (95% confidence interval
[CI], 23.2–53.7) and 48% (95% CI, 28.4–67.6) to 83.3% (95% CI, 70.0–96.7),
respectively. Similar proportions of patients with ongoing barriers to care
were treated during the PEG-IFN/RBV (25 of 39 [64%]), PEG-IFN/RBV/PI (14 of 25
[56%]), and IFN-free DAA (16 of 30 [53%]) eras. Hepatitis C virus SVR among
patients with ongoing barriers to care improved from 40% (95% CI, 21–59) to
76.5% (95% CI, 56–97) in the PEG-IFN/RBV and IFN-free DAA eras, respectively.
After stratification for factors associated with HCV SVR such as HCV genotype
and cirrhosis, HCV SVR were similar in patients regardless of the presence of
ongoing barriers to care.
Conclusions. Using
IFN-free DAA and an inclusive HCV treatment protocol, 76.5% of HIV/HCV-treated
patients with ongoing barriers to care achieved HCV SVR.
Below: Error bars plot depicting
proportion of hepatitis C virus sustained viral response (SVR) achieved during
each treatment era in an unadjusted model (left panel) and adjusted multiple
logistic regression model of treatment period controlling for barriers to care
(drug/alcohol abuse, psychiatric disease, unstable housing), genotype 1,
cirrhosis, and presence of severe concurrent medical comorbidities (right
panel). Abbreviations: C.I., confidence interval; DAA, direct-acting
antivirals; pIF/RBV/PI, pegylated-interferon, ribavirin and HCV protease
inhibitor (telaprevir) era.
Full article at: http://goo.gl/JspckK
By: Edward R. Cachay,1,2 David Wyles,1,2 Lucas Hill,3 Craig Ballard,1,3 Francesca Torriani,1,2 Bradford Colwell,1,3Alexander Kuo,4 Robert Schooley,2 and Christopher W. Mathews1
1Department of Medicine, Owen Clinic
2Department of Medicine, Division of
Infectious Diseases
3Skaggs School of Pharmacy and Pharmaceutical
Sciences
4Department of Medicine, Division of
Gastroenterology and Hepatology, University of California San Diego
Correspondence: Edward R. Cachay, MD, MAS, University of
California at San Diego, 200 W. Arbor Drive, San Diego, CA 92103-8681 (Email:ude.dscu@yahcace).
More at: https://twitter.com/hiv_insight
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