Protease inhibitors to treat hepatitis C in the Swiss HIV Cohort Study: high efficacy but low treatment uptake

Publication

Protease inhibitors to treat hepatitis C in the Swiss HIV Cohort Study: high efficacy but low treatment uptake

Journal Paper/Review - Jul 2, 2015

Schaerer V, Rauch A, Fehr J, Metzner K J, Furrer H, Günthard H F, Böni J, Aouri M, Decosterd L, Schmid Patrick, Stoeckle M, Cavassini M, Ambrosioni J, Ledergerber B, Kovari H, Haubitz S, Swiss HIV Cohort Study

Citation

Schaerer V, Rauch A, Fehr J, Metzner K, Furrer H, Günthard H, Böni J, Aouri M, Decosterd L, Schmid P, Stoeckle M, Cavassini M, Ambrosioni J, Ledergerber B, Kovari H, Haubitz S, Swiss HIV Cohort Study. Protease inhibitors to treat hepatitis C in the Swiss HIV Cohort Study: high efficacy but low treatment uptake. HIV Med 2015; 16:599-607.

Type

Journal Paper/Review (English)

Journal

HIV Med 2015; 16

Publication Date

Jul 2, 2015

Issn Electronic

1468-1293

Pages

599-607

Brief description/objective

OBJECTIVES
Direct-acting antiviral agents (DAAs) have become the standard of care for the treatment of chronic hepatitis C virus (HCV) infection. We aimed to assess treatment uptake and efficacy in routine clinical settings among HIV/HCV coinfected patients after the introduction of the first generation DAAs.

METHODS
Data on all Swiss HIV Cohort Study (SHCS) participants starting HCV protease inhibitor (PI) treatment between September 2011 and August 2013 were collected prospectively. The uptake and efficacy of HCV therapy were compared with those in the time period before the availability of PIs.

RESULTS
Upon approval of PI treatment in Switzerland in September 2011, 516 SHCS participants had chronic HCV genotype 1 infection. Of these, 57 (11%) started HCV treatment during the following 2 years with either telaprevir, faldaprevir or boceprevir. Twenty-seven (47%) patients were treatment-naïve, nine (16%) were patients with relapse and 21 (37%) were partial or null responders. Twenty-nine (57%) had advanced fibrosis and 15 (29%) had cirrhosis. End-of-treatment virological response was 84% in treatment-naïve patients, 88% in patients with relapse and 62% in previous nonresponders. Sustained virological response was 78%, 86% and 40% in treatment-naïve patients, patients with relapse and nonresponders, respectively. Treatment uptake was similar before (3.8 per 100 patient-years) and after (6.1 per 100 patient-years) the introduction of PIs, while treatment efficacy increased considerably after the introduction of PIs.

CONCLUSIONS
The introduction of PI-based HCV treatment in HIV/HCV-coinfected patients improved virological response rates, while treatment uptake remained low. Therefore, the introduction of PIs into the clinical routine was beneficial at the individual level, but had only a modest effect on the burden of HCV infection at the population level.