Infectious Diseases Unit, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía de Córdoba, Universidad de Córdoba, Córdoba, Spain.
Infectious Diseases Unit, Hospital Universitario de Puerto Real, Instituto de Investigación e Innovación en Ciencias Biomédicas de la Provincia de Cádiz, Universidad de Cádiz, Cádiz, Spain.
HIV Med. 2019 Jul;20(6):359-367. doi: 10.1111/hiv.12715. Epub 2019 Apr 22.
Our objective was to identify patient factors associated with being untreated for hepatitis C virus (HCV) infection in HIV-coinfected patients.
A prospective longitudinal study was carried out. HIV-infected patients with active chronic HCV infection included in the HERACLES cohort (NCT02511496) constituted the study population. The main study outcome was receipt of HCV direct-acting antiviral (DAA) treatment from 1 May 2015 to 1 May 2017. The population was divided into patients who were receiving HCV treatment during follow-up and those who were not.
Of the 15 556 HIV-infected patients in care, 3075 (19.7%) presented with chronic HCV infection and constituted the study population. At the end of the follow-up, 1957 patients initiated HCV therapy (63.6%). Age < 50 years, absence of or minimal liver fibrosis, being treatment-naïve, HCV genotype 3 infection, being in the category of people who inject drugs using opioid substitutive therapy (OST-PWID), and being in the category of recent PWID were identified as significant independent risk factors associated with low odds of DAA implementation. When a multivariate analysis was performed including only the PWID population, both OST-PWID [odds ratio (OR) 0.552; 95% confidence interval (CI) 0.409-0.746) and recent PWID (OR 0.019; 95% CI 0.004-0.087) were identified as independent factors associated with low odds of treatment implementation.
We identified factors, which did not include prioritization of a DAA uptake strategy, that limited access to HCV therapy. The low treatment uptake in several populations seriously jeopardizes the elimination of HCV infection in the coming years.
我们的目的是确定与 HIV 合并感染的丙型肝炎病毒（HCV）感染者未接受治疗相关的患者因素。
进行了一项前瞻性纵向研究。HERACLES 队列（NCT02511496）中纳入的活跃慢性 HCV 感染的 HIV 感染者构成了研究人群。主要研究结果是在 2015 年 5 月 1 日至 2017 年 5 月 1 日期间接受 HCV 直接作用抗病毒（DAA）治疗。人群分为随访期间接受 HCV 治疗的患者和未接受治疗的患者。
在接受护理的 15556 名 HIV 感染者中，有 3075 名（19.7%）患有慢性 HCV 感染，构成了研究人群。随访结束时，1957 名患者开始 HCV 治疗（63.6%）。年龄<50 岁、无或轻度肝纤维化、初治、HCV 基因型 3 感染、使用阿片类药物替代治疗（OST-PWID）的药物滥用者和近期药物滥用者被确定为与 DAA 实施可能性降低相关的显著独立危险因素。当仅对药物滥用者人群进行多变量分析时，OST-PWID[比值比（OR）0.552；95%置信区间（CI）0.409-0.746]和近期药物滥用者（OR 0.019；95%CI 0.004-0.087）被确定为与治疗可能性降低相关的独立因素。
我们确定了一些因素，这些因素不包括 DAA 采用策略的优先级，这些因素限制了 HCV 治疗的获得。在多个人群中，低治疗率严重威胁着未来几年消除 HCV 感染的目标。
