Low hepatitis C virus-viremia prevalence yet continued barriers to direct-acting antiviral treatment in people living with HIV in the Netherlands

Cas J Isfordink, Colette Smit, Anders Boyd, Marieke J A de Regt, Bart J A Rijnders, Reinout van Crevel, Robin P Ackens, Peter Reiss, Joop E Arends, Marc van der Valk*, ATHENA observational cohort

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)773-783
Number of pages11
JournalAids
Volume36
Issue number6
Early online date6 Jan 2022
DOIs
Publication statusPublished - 1 May 2022

Keywords

  • HIV
  • elimination
  • hepatitis C
  • hepatitis C virus co-infection
  • micro-elimination
  • treatment uptake

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