Saturday, December 26, 2015

The Impact of Direct-Acting Antivirals in the Hepatitis C-Sustained Viral Response in HIV-Infected Patients with Ongoing Barriers to Care

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:

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).

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