Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Zurich, University of Zurich, Switzerland.
Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Zurich, University of Zurich, Switzerland.
J Hepatol. 2015 Sep;63(3):573-80. doi: 10.1016/j.jhep.2015.04.019. Epub 2015 May 1.
BACKGROUND & AIMS: The landscape of HCV treatments is changing dramatically. At the beginning of this new era, we highlight the challenges for HCV therapy by assessing the long-term epidemiological trends in treatment uptake, efficacy and mortality among HIV/HCV-coinfected people since the availability of HCV therapy.
We included all SHCS participants with detectable HCV RNA between 2001 and 2013. To identify predictors for treatment uptake uni- and multivariable Poisson regression models were applied. We further used survival analyses with Kaplan-Meier curves and Cox regression with drop-out as competing risk.
Of 12,401 participants 2107 (17%) were HCV RNA positive. Of those, 636 (30%) started treatment with an incidence of 5.8/100 person years (PY) (95% CI 5.3-6.2). Sustained virological response (SVR) with pegylated interferon/ribavirin was achieved in 50% of treated patients, representing 15% of all participants with replicating HCV-infection. 344 of 2107 (16%) HCV RNA positive persons died, 59% from extrahepatic causes. Mortality/100 PY was 2.9 (95% CI 2.6-3.2) in untreated patients, 1.3 (1.0-1.8) in those treated with failure, and 0.6 (0.4-1.0) in patients with SVR. In 2013, 869/2107 (41%) participants remained HCV RNA positive.
Over the last 13 years HCV treatment uptake was low and by the end of 2013, a large number of persons remain to be treated. Mortality was high, particularly in untreated patients, and mainly due to non-liver-related causes. Accordingly, in HIV/HCV-coinfected patients, integrative care including the diagnosis and therapy of somatic and psychiatric disorders is important to achieve mortality rates similar to HIV-monoinfected patients.
丙型肝炎病毒（HCV）治疗领域正在发生重大变化。在这个新时代的开端，我们通过评估自 HCV 治疗可用以来，HIV/HCV 合并感染人群中治疗接受率、疗效和死亡率的长期流行病学趋势，强调 HCV 治疗面临的挑战。
我们纳入了 2001 年至 2013 年间 SHCS 中可检测到 HCV RNA 的所有参与者。采用单变量和多变量泊松回归模型评估治疗接受率的预测因素。我们还使用生存分析Kaplan-Meier 曲线和 Cox 回归，将失访作为竞争风险。
在 12401 名参与者中，2107 名（17%）HCV RNA 阳性。其中，636 名（30%）开始接受治疗，发生率为 5.8/100 人年（95%CI 5.3-6.2）。接受聚乙二醇干扰素/利巴韦林治疗的患者中，持续病毒学应答（SVR）的比例为 50%，占所有复制性 HCV 感染患者的 15%。2107 名 HCV RNA 阳性患者中有 344 人死亡，59%死于肝外原因。未治疗患者的死亡率为 2.9/100 人年（95%CI 2.6-3.2），治疗失败的患者为 1.3/100 人年（1.0-1.8），SVR 患者为 0.6/100 人年（0.4-1.0）。2013 年，2107 名患者中有 869 名（41%）仍为 HCV RNA 阳性。
在过去 13 年中，HCV 治疗接受率较低，截至 2013 年底，仍有大量患者需要治疗。死亡率较高，特别是在未治疗的患者中，主要是非肝脏相关原因。因此，在 HIV/HCV 合并感染患者中，包括躯体和精神障碍诊断和治疗在内的综合治疗对于实现与 HIV 单感染患者相似的死亡率非常重要。
