TY - JOUR
T1 - Low hepatitis C virus-viremia prevalence yet continued barriers to direct-acting antiviral treatment in people living with HIV in the Netherlands
AU - Isfordink, Cas J
AU - Smit, Colette
AU - Boyd, Anders
AU - de Regt, Marieke J A
AU - Rijnders, Bart J A
AU - van Crevel, Reinout
AU - Ackens, Robin P
AU - Reiss, Peter
AU - Arends, Joop E
AU - van der Valk, Marc
AU - ATHENA observational cohort
N1 - Copyright © 2022 Wolters Kluwer Health, Inc.
PY - 2022/5/1
Y1 - 2022/5/1
N2 - OBJECTIVE: To describe hepatitis C virus (HCV)-viremia prevalence and barriers to direct-acting antiviral (DAA) treatment during unrestricted access to DAA in a nationwide cohort of people living with HIV (PLWH).DESIGN: Retrospective analysis of prospectively-collected data.METHODS: We calculated yearly HCV-viremia prevalence as proportion of HCV RNA-positive individuals ever HCV-tested. We then included HCV-viremic individuals with ≥1 visit during the era of universal DAA-access (database lock=31 December 2018). Based on their last visit, individuals were grouped as DAA-treated or -untreated. Variables associated with lack of DAA-treatment were assessed using targeted maximum likelihood estimation. In November 2020, physicians of DAA-untreated individuals completed a questionnaire on barriers to DAA-uptake and onward HCV-transmission risk.RESULTS: Among 25,196 PLWH, HCV-viremia decreased from 4-5% between 2000-2014 to 0.6% in 2019. Being DAA-untreated was associated with HIV-transmission route other than men who have sex with men, older age, infrequent follow-up, severe alcohol use, detectable HIV-RNA, HCV-genotype 3, and larger hospital size. With universal DAA-access, 72/979 HCV-viremic individuals remained DAA-untreated at their last visit. Of these, 39 were no longer in care, 27 remained DAA-untreated in care, and six initiated DAA since database lock. Most common physician-reported barriers to DAA-uptake were patient refusal (20/72, 28%) and infrequent visit attendance (19/72, 26%). Only one DAA-untreated individual in care was engaging in activities associated with onward HCV-transmission.CONCLUSIONS: Prevalence of HCV-viremic PLWH is low in the Netherlands, coinciding with widespread DAA-uptake. Barriers to DAA-uptake appear mostly patient-related, while HCV-transmission seems unlikely from the few DAA-untreated in care.
AB - OBJECTIVE: To describe hepatitis C virus (HCV)-viremia prevalence and barriers to direct-acting antiviral (DAA) treatment during unrestricted access to DAA in a nationwide cohort of people living with HIV (PLWH).DESIGN: Retrospective analysis of prospectively-collected data.METHODS: We calculated yearly HCV-viremia prevalence as proportion of HCV RNA-positive individuals ever HCV-tested. We then included HCV-viremic individuals with ≥1 visit during the era of universal DAA-access (database lock=31 December 2018). Based on their last visit, individuals were grouped as DAA-treated or -untreated. Variables associated with lack of DAA-treatment were assessed using targeted maximum likelihood estimation. In November 2020, physicians of DAA-untreated individuals completed a questionnaire on barriers to DAA-uptake and onward HCV-transmission risk.RESULTS: Among 25,196 PLWH, HCV-viremia decreased from 4-5% between 2000-2014 to 0.6% in 2019. Being DAA-untreated was associated with HIV-transmission route other than men who have sex with men, older age, infrequent follow-up, severe alcohol use, detectable HIV-RNA, HCV-genotype 3, and larger hospital size. With universal DAA-access, 72/979 HCV-viremic individuals remained DAA-untreated at their last visit. Of these, 39 were no longer in care, 27 remained DAA-untreated in care, and six initiated DAA since database lock. Most common physician-reported barriers to DAA-uptake were patient refusal (20/72, 28%) and infrequent visit attendance (19/72, 26%). Only one DAA-untreated individual in care was engaging in activities associated with onward HCV-transmission.CONCLUSIONS: Prevalence of HCV-viremic PLWH is low in the Netherlands, coinciding with widespread DAA-uptake. Barriers to DAA-uptake appear mostly patient-related, while HCV-transmission seems unlikely from the few DAA-untreated in care.
KW - HIV
KW - elimination
KW - hepatitis C
KW - hepatitis C virus co-infection
KW - micro-elimination
KW - treatment uptake
U2 - 10.1097/QAD.0000000000003159
DO - 10.1097/QAD.0000000000003159
M3 - Article
C2 - 34999607
SN - 0269-9370
VL - 36
SP - 773
EP - 783
JO - Aids
JF - Aids
IS - 6
ER -