Roberson Jeffrey L, Lagasca Alicia M, Kan Virginia L
1 Department of Medicine, The George Washington University School of Medicine and Health Sciences , Washington, District of Columbia.
2 Veterans Affairs Medical Center, The George Washington University School of Medicine and Health Sciences , Washington, District of Columbia.
AIDS Res Hum Retroviruses. 2018 Feb;34(2):148-155. doi: 10.1089/AID.2017.0092. Epub 2017 Nov 8.
Treatment of chronic hepatitis C virus (HCV) infection included use of pegylated interferon-based regimens before 2014 and direct-acting agents (DAA) since 2014 at the VA Medical Center in Washington, DC. We compared the continua of care between our HCV/HIV coinfected and HCV mono-infected patients during 2008-2015. A review of summary data from our local HCV Clinical Case Registry was conducted for the interferon treatment era (2008-2013) and the DAA era (2014-2015). Data were analyzed on a modified HCV Continuum of Care based on these stages: HCV diagnosis, engagement in medical care, HCV treatment, and HCV sustained virologic response (SVR) for differences between HCV/HIV coinfected and HCV mono-infected patients. All patients had 88% engagement in primary care during 2008-2013. HCV mono-infected and HCV/HIV coinfected patients had similar treatment (6% vs. 5%, p = .6622) and HCV SVR (1% vs. 0.5%, p = .1737) rates in the interferon era. However, more HCV/HIV coinfected patients were engaged in care (93% vs. 87%, p = .0044), accessed HCV treatment (36% vs. 23%, p < .0001), and achieved HCV SVR (31% vs. 21% p = .0002) compared to mono-infected patients in the DAA era. Both HCV/HIV coinfected and HCV mono-infected patients achieved higher SVR of ≥86% after DAA treatment. Although improvements were seen for treatment and SVR among HCV mono-infected patients, better rates for care engagement, HCV treatment, and SVR were realized for HCV/HIV coinfected patients in the DAA era.
在华盛顿特区的退伍军人事务医疗中心，慢性丙型肝炎病毒（HCV）感染的治疗在2014年前采用基于聚乙二醇化干扰素的治疗方案，自2014年起使用直接抗病毒药物（DAA）。我们比较了2008 - 2015年间HCV/HIV合并感染患者和HCV单一感染患者的连续治疗情况。对我们当地HCV临床病例登记处干扰素治疗时代（2008 - 2013年）和DAA时代（2014 - 2015年）的汇总数据进行了回顾。基于HCV诊断、参与医疗护理、HCV治疗以及HCV持续病毒学应答（SVR）这些阶段，对修改后的HCV连续治疗情况进行数据分析，以比较HCV/HIV合并感染患者和HCV单一感染患者之间的差异。在2008 - 2013年间，所有患者在初级保健中的参与率为88%。在干扰素时代，HCV单一感染患者和HCV/HIV合并感染患者的治疗率（6%对5%，p = 0.6622）和HCV SVR率（1%对0.5%，p = 0.1737）相似。然而，在DAA时代，与单一感染患者相比，更多的HCV/HIV合并感染患者参与了护理（93%对87%，p = 0.0044），接受了HCV治疗（36%对23%，p < 0.0001），并实现了HCV SVR（31%对21%，p = 0.0002）。在接受DAA治疗后，HCV/HIV合并感染患者和HCV单一感染患者均实现了≥86%的更高SVR。尽管HCV单一感染患者在治疗和SVR方面有所改善，但在DAA时代，HCV/HIV合并感染患者在护理参与、HCV治疗和SVR方面实现了更高的比率。
