High Treatment Uptake in Human Immunodeficiency Virus/Hepatitis C Virus-Coinfected Patients After Unrestricted Access to Direct-Acting Antivirals in the Netherlands
High Treatment Uptake in Human Immunodeficiency Virus/Hepatitis C Virus-Coinfected Patients After Unrestricted Access to Direct-Acting Antivirals in the Netherlands
复制标题
DOI：
10.1093/cid/cix1004
复制
发表时间：
2018-05-01
影响因子：
11.8
通讯作者：
van der Valk, Marc
中科院分区：
文献类型：
--
作者：
Boerekamps, Anne;Newsum, Astrid M.;van der Valk, Marc
背景。荷兰自 2015 年 11 月起提供无限制的直接作用抗病毒药物 (DAA)。我们分析了全国范围内同时感染人类免疫缺陷病毒 (HIV) 和 HCV 的丙型肝炎病毒 (HCV) 治疗情况。方法。数据来自 ATHENA HIV 观察队列，其中包括自 1998 年以来登记的超过 98% 的 HIV 感染患者。如果患者曾有 1 次 HCV RNA 结果呈阳性、没有自发清除且已知仍在接受治疗，则将其纳入。评估了治疗的吸收和结果。当患者接受多次治疗时，仅包含最近一次治疗的数据。数据更新至2017年2月。此外，各治疗中心于2017年4月询问了DAA治疗的数据更新，并取得了持续病毒学应答的结果。在 23574 名曾接受护理的 HIV 感染患者中，1471 名 HCV 合并感染患者（69% 为男男性行为者，15% 曾注射吸毒者，15% 为其他 HIV 传播途径）符合纳入标准。其中，87%（1471人中的1284人）在2000年至2017年间曾开始HCV治疗，76%（1471人中的1124人）HCV感染被治愈； 6% 的 DAA 治疗结果尚未确定（1471 人中有 92 人）。在男男性行为者中，83%（1022 人中的 844 人）的 HCV 感染得到治愈，6% 的人（1022 人中的 66 人）正在等待 DAA 治疗结果。总体而言，187 名患者从未开始治疗，14 名患者的 DAA 失败，54 名基于聚乙二醇干扰素-α 的治疗方案失败。结论。在不受限制地使用 DAA 15 个月后，荷兰大多数 HIV/HCV 合并感染患者的 HCV 感染已治愈（76%）或正在等待 DAA 治疗结果（6%）。这种快速扩大治疗规模可能有助于未来消除这些患者中的丙型肝炎病毒。
Background. The Netherlands has provided unrestricted access to direct-acting antivirals (DAAs) since November 2015. We analyzed the nationwide hepatitis C virus (HCV) treatment uptake among patients coinfected with human immunodeficiency virus (HIV) and HCV.Methods. Data were obtained from the ATHENA HIV observational cohort in which >98% of HIV-infected patients ever registered since 1998 are included. Patients were included if they ever had 1 positive HCV RNA result, did not have spontaneous clearance, and were known to still be in care. Treatment uptake and outcome were assessed. When patients were treated more than once, data were included from only the most recent treatment episode. Data were updated until February 2017. In addition, each treatment center was queried in April 2017 for a data update on DAA treatment and achieved sustained virological response.Results. Of 23 574 HIV-infected patients ever linked to care, 1471 HCV-coinfected patients (69% men who have sex with men, 15% persons who [formerly] injected drugs, and 15% with another HIV transmission route) fulfilled the inclusion criteria. Of these, 87% (1284 of 1471) had ever initiated HCV treatment between 2000 and 2017, 76% (1124 of 1471) had their HCV infection cured; DAA treatment results were pending in 6% (92 of 1471). Among men who have sex with men, 83% (844 of 1022) had their HCV infection cured, and DAA treatment results were pending in 6% (66 of 1022). Overall, 187 patients had never initiated treatment, DAAs had failed in 14, and a pegylated interferon-alfa-based regimen had failed in 54.Conclusions. Fifteen months after unrestricted DAA availability the majority of HIV/HCV-coinfected patients in the Netherlands have their HCV infection cured (76%) or are awaiting DAA treatment results (6%). This rapid treatment scale-up may contribute to future HCV elimination among these patients.