Retrospective study of hepatitis C outcomes and treatment in HIV co-infected persons from the Australian HIV Observational Database
Rainer Puhr A I , Stephen T. Wright A B , Jennifer F. Hoy C D , David J. Templeton A E , Nicolas Durier F G , Gail V. Matthews A , Darren Russell H and Matthew G. Law AA The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia.
B School of Mathematical and Physical Sciences, University of Technology, Sydney, NSW 2007, Australia.
C The Alfred Hospital, Melbourne, Vic. 3004, Australia.
D Department of Medicine, Monash University, Melbourne, Vic. 3800, Australia.
E RPA Sexual Health, Sydney Local Health District, Sydney, NSW 2050, Australia.
F TREAT Asia, amfAR-The Foundation for AIDS Research, Bangkok 10110, Thailand.
G Current address: Dreamlopments enterprise, Bangkok 10400, Thailand.
H Cairns Sexual Health Service, Cairns, Qld 4870, Australia.
I Corresponding author. Email: rpuhr@kirby.unsw.edu.au
Sexual Health 14(4) 345-354 https://doi.org/10.1071/SH16151
Submitted: 11 August 2016 Accepted: 18 March 2017 Published: 9 May 2017
Abstract
Background: The widespread availability of direct-acting antivirals (DAAs) is expected to drastically improve the treatment uptake and cure rate of hepatitis C virus (HCV). In this paper, rates of and factors associated with HCV treatment uptake and cure in the HIV co-infected population in Australia were assessed before access to DAAs. Methods: The medical records of patients in the Australian HIV Observational Database who were reported to be HCV antibody positive from 1999 to 2014 were reviewed for HCV treatment data. Patients with detectable HCV RNA were included in this analysis. Logistic regression models were applied to identify factors associated with treatment uptake and HCV sustained virological response (SVR) 24 weeks’ post treatment. Results: The median follow-up time of those with chronic HCV/HIV co-infection was 103 months (interquartile range 51–166 months). Of 179 HCV viraemic patients, 79 (44.1%) began treatment. In the adjusted model, a higher METAVIR score was the only significant factor associated with treatment uptake (odds ratio (OR) 8.87, 95% confidence interval (CI) 2.00–39.3, P = 0.004). SVR was achieved in 37 (50%) of 74 treated patients. HCV genotypes 2/3 compared with 1/4 remained the only significant factor for SVR in an adjusted multivariable setting (OR 5.44, 95% CI 1.53–19.4, P = 0.009). Conclusions: HCV treatment uptake and SVR have been relatively low in the era of interferon-containing regimens, in Australian HIV/HCV coinfected patients. With new and better tolerated DAAs, treatment of HCV is likely to become more accessible, and identification and treatment of HCV in co-infected patients should become a priority.
Additional keywords: hepatitis C, HCV/HIV co-infection, HCV treatment uptake, sustained virological response, HIV.
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