3 years ago

Access and response to direct antiviral agents (DAA) in HIV-HCV co-infected patients in Italy: Data from the Icona cohort

Alessandro Cozzi-Lepri, Milensu Shanyinde, Francesca Ceccherini-Silberstein, Enrico Girardi, Massimo Andreoni, on behalf of Icona Foundation, Andrea Antinori, Alessandro Tavelli, Andrea Gori, HepaIcona Study Group, Antonella d'Arminio Monforte, Sergio Lo Caputo, Antonella Cingolani, Antonella Castagna, Andrea De Luca, Cristina Mussini, Massimo Puoti

by Antonella d'Arminio Monforte, Alessandro Cozzi-Lepri, Francesca Ceccherini-Silberstein, Andrea De Luca, Sergio Lo Caputo, Antonella Castagna, Cristina Mussini, Antonella Cingolani, Alessandro Tavelli, Milensu Shanyinde, Andrea Gori, Enrico Girardi, Massimo Andreoni, Andrea Antinori, Massimo Puoti, on behalf of Icona Foundation and HepaIcona Study Group

Background

Real-life data on access and response to direct antiviral agents (DAA) in HIV-HCV coinfected individuals are lacking.

Methods

HCV viremic, HIV-positive patients from Icona and Hepaicona cohorts naïve to DAA by January 2013 were included. Access and predictors of starting DAA were evaluated. Switches of antiretroviral drugs at starting DAA were described. We calculated sustained virological response (SVR12) in those reaching 12 weeks after end-of-treatment (EOT), and defined treatment failure (TF) as discontinuation of DAA before EOT or non-SVR12. Statistical analyses included Kaplan-Meier curves, univariable and multivariable analyses evaluating predictors of access to DAA and of treatment outcome (non-SVR and TF).

Results

2,607 patients included. During a median follow-up of 38 (IQR:30–41) months, 920 (35.3%) patients started DAA. Eligibility for reimbursement was the strongest predictor to access to treatment: 761/1,090 (69.8%) eligible and 159/1,517 (10.5%) non-eligible to DAA reimbursement. Older age, HIV-RNA≤50 copies/mL were associated to faster DAA initiation, higher CD4 count and HCV-genotype 3 with delayed DAA initiation in those eligible to DAA reimbursement. Up to 28% of patients (36% of those on ritonavir-boosted protease inhibitors, PI/r) underwent antiretroviral (ART) modification at DAA initiation. 545/595 (91.6%) patients reaching EOT achieved SVR12. Overall, TF occurred in 61/606 patients (10.1%), with 11 discontinuing DAA before EOT. Suboptimal DAA was the only independent predictor of both non-SVR12 (AHR 2.52, 95%CI:1.24–5.12) and TF (AHR: 2.19; 95%CI:1.13–4.22).

Conclusions

Only 35.3% had access to HCV treatment. Despite excellent rates of SVR12 rates (91.6%), only 21% (545/2,607) of our HIV-HCV co-infected patients are cured.

Publisher URL: http://journals.plos.org/plosone/article

DOI: 10.1371/journal.pone.0177402

You might also like
Discover & Discuss Important Research

Keeping up-to-date with research can feel impossible, with papers being published faster than you'll ever be able to read them. That's where Researcher comes in: we're simplifying discovery and making important discussions happen. With over 19,000 sources, including peer-reviewed journals, preprints, blogs, universities, podcasts and Live events across 10 research areas, you'll never miss what's important to you. It's like social media, but better. Oh, and we should mention - it's free.

  • Download from Google Play
  • Download from App Store
  • Download from AppInChina

Researcher displays publicly available abstracts and doesn’t host any full article content. If the content is open access, we will direct clicks from the abstracts to the publisher website and display the PDF copy on our platform. Clicks to view the full text will be directed to the publisher website, where only users with subscriptions or access through their institution are able to view the full article.