David Geffen School of Medicine, UCLA, Los Angeles, California, USA.
Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA.
J Gastroenterol Hepatol. 2021 Apr;36(4):1095-1102. doi: 10.1111/jgh.15228. Epub 2020 Sep 8.
Direct-acting antivirals (DAAs) have increased hepatitis C virus (HCV) treatment opportunities for vulnerable HIV/HCV coinfected persons. The aim of this study was to identify the frequency of and potential barriers to DAA prescription in HIV/HCV patients during the first few years of DAA availability in the United States.
The AIDS Healthcare Foundation electronic medical record system was queried to identify all HCV viremic HIV-infected patients in care at AIDS Healthcare Foundation Healthcare centers in January 2015-August 2017 and compare characteristics by receipt of a DAA prescription. Multivariate logistic regression analyses were conducted to examine factors associated with DAA prescription.
Of 826 eligible patients, 355 (43%) were prescribed a DAA; among those not prescribed a DAA, 301 (64%) had well-controlled HIV (HIV RNA ≤ 200 copies per mL). In multivariate logistic regression analysis, patients with a history of substance use (odds ratio [OR], 0.51 [95% confidence interval 0.35-0.73]) or on select HIV antiretroviral regimens were less likely to be prescribed a DAA. Those who had well-controlled HIV (OR, 5.03 [3.06-8.27]), CD4 + T cell count >200 cells per mm (OR, 1.85 [1.04-3.30]), estimated glomerular filtration rate >60 mL/min/1.73 m (OR, 3.32 [1.08-10.15]), or established care prior to January 2015 (OR, 1.57 [1.08-2.29] were more likely to be prescribed a DAA.
In addition to lack of HIV suppression, select antiretroviral regimens, substance use, and kidney disease appeared to limit DAA prescription in the early interferon-free DAA era. Many were not prescribed DAAs despite HIV suppression. Further research is needed to determine if the observed associations persist today.
直接作用抗病毒药物（DAAs）增加了易感染艾滋病毒/丙型肝炎病毒（HCV）的脆弱人群的 HCV 治疗机会。本研究的目的是确定在美国 DAA 上市的最初几年中，HIV/HCV 合并感染患者中 DAA 处方的频率和潜在障碍。
通过查询艾滋病保健基金会电子病历系统，确定 2015 年 1 月至 2017 年 8 月在艾滋病保健基金会医疗中心接受治疗的所有 HCV 病毒血症 HIV 感染患者，并比较接受 DAA 处方的患者的特征。采用多变量 logistic 回归分析方法，分析与 DAA 处方相关的因素。
在 826 名合格患者中，355 名（43%）被开具了 DAA 处方；在未开具 DAA 处方的患者中，301 名（64%）HIV 得到了很好的控制（HIV RNA≤200 拷贝/ml）。在多变量 logistic 回归分析中，有药物滥用史（比值比[OR]，0.51[95%置信区间 0.35-0.73]）或使用特定 HIV 抗逆转录病毒方案的患者开具 DAA 的可能性较低。HIV 得到很好控制（OR，5.03[3.06-8.27]）、CD4+T 细胞计数>200 个/平方毫米（OR，1.85[1.04-3.30]）、估计肾小球滤过率>60ml/min/1.73m（OR，3.32[1.08-10.15]）或在 2015 年 1 月之前建立治疗关系的患者更有可能被开具 DAA 处方。
除了 HIV 抑制不足外，选择的抗逆转录病毒方案、药物滥用和肾脏疾病似乎限制了早期无干扰素 DAA 时代 DAA 的处方。尽管 HIV 得到了抑制，但许多人没有被开具 DAA 处方。需要进一步研究以确定观察到的关联是否仍然存在。
