Puhr Rainer, Wright Stephen T, Hoy Jennifer F, Templeton David J, Durier Nicolas, Matthews Gail V, Russell Darren, Law Matthew G
The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia.
The Alfred Hospital, Melbourne, Vic. 3004, Australia.
Sex Health. 2017 Aug;14(4):345-354. doi: 10.1071/SH16151.
The widespread availability of direct-acting antivirals (DAAs) is expected to drastically improve the treatment uptake and cure rate of hepatitis C virus (HCV). In this paper, rates of and factors associated with HCV treatment uptake and cure in the HIV co-infected population in Australia were assessed before access to DAAs.
The medical records of patients in the Australian HIV Observational Database who were reported to be HCV antibody positive from 1999 to 2014 were reviewed for HCV treatment data. Patients with detectable HCV RNA were included in this analysis. Logistic regression models were applied to identify factors associated with treatment uptake and HCV sustained virological response (SVR) 24 weeks' post treatment.
The median follow-up time of those with chronic HCV/HIV co-infection was 103 months (interquartile range 51-166 months). Of 179 HCV viraemic patients, 79 (44.1%) began treatment. In the adjusted model, a higher METAVIR score was the only significant factor associated with treatment uptake (odds ratio (OR) 8.87, 95% confidence interval (CI) 2.00-39.3, P=0.004). SVR was achieved in 37 (50%) of 74 treated patients. HCV genotypes 2/3 compared with 1/4 remained the only significant factor for SVR in an adjusted multivariable setting (OR 5.44, 95% CI 1.53-19.4, P=0.009).
HCV treatment uptake and SVR have been relatively low in the era of interferon-containing regimens, in Australian HIV/HCV coinfected patients. With new and better tolerated DAAs, treatment of HCV is likely to become more accessible, and identification and treatment of HCV in co-infected patients should become a priority.
直接抗病毒药物（DAA）的广泛可得有望大幅提高丙型肝炎病毒（HCV）的治疗接受率和治愈率。本文在澳大利亚可获取DAA之前，评估了澳大利亚HIV合并感染人群中HCV治疗接受率及与之相关的因素和治愈率。
回顾了澳大利亚HIV观察数据库中1999年至2014年报告HCV抗体阳性患者的病历以获取HCV治疗数据。可检测到HCV RNA的患者纳入本分析。应用逻辑回归模型确定与治疗接受率及治疗后24周HCV持续病毒学应答（SVR）相关的因素。
慢性HCV/HIV合并感染患者的中位随访时间为103个月（四分位间距51 - 166个月）。179例HCV病毒血症患者中，79例（44.1%）开始治疗。在调整模型中，较高的METAVIR评分是与治疗接受率相关的唯一显著因素（比值比（OR）8.87，95%置信区间（CI）2.00 - 39.3，P = 0.004）。74例接受治疗的患者中有37例（50%）实现了SVR。在调整后的多变量分析中，与1/4型相比，2/3型HCV基因型仍然是SVR的唯一显著因素（OR 5.44，95% CI 1.53 - 19.4，P = 0.009）。
在含干扰素治疗方案时代，澳大利亚HIV/HCV合并感染患者的HCV治疗接受率和SVR相对较低。随着耐受性更好的新型DAA出现，HCV治疗可能会更容易获得，对合并感染患者中HCV的识别和治疗应成为优先事项。
