Abstract
Objective:To describe hepatitis C virus (HCV)-viremia prevalence and barriers to direct-acting antiviral (DAA) treatment during unrestricted access to DAA in a nationwide cohort of people with HIV (PWH).Design:Retrospective analysis of prospectively collected data.Methods:We calculated yearly HCV-viremia prevalence as proportion of HCV RNA-positive individuals ever HCV-tested. We then included HCV-viremic individuals with ≥1 visit during the era of universal DAA-access (database lock = December 31, 2018). Based on their last visit, individuals were grouped as DAA-treated or -untreated. Variables associated with lack of DAA-treatment were assessed using targeted maximum likelihood estimation. In November 2020, physicians of DAA-untreated individuals completed a questionnaire on barriers to DAA-uptake and onward HCV-transmission risk.Results:Among 25 196 PWH, HCV-viremia decreased from 4% to 5% between 2000 and 2014 to 0.6% in 2019. Being DAA-untreated was associated with HIV-transmission route other than men who have sex with men, older age, infrequent follow-up, severe alcohol use, detectable HIV-RNA, HCV-genotype 3, and larger hospital size. With universal DAA-access, 72 of 979 HCV-viremic individuals remained DAA-untreated at their last visit. Of these, 39 were no longer in care, 27 remained DAA-untreated in care, and six initiated DAA since database lock. Most common physician-reported barriers to DAA-uptake were patient refusal (20/72, 28%) and infrequent visit attendance (19/72, 26%). Only one DAA-untreated individual in care was engaging in activities associated with onward HCV-transmission.Conclusions:Prevalence of HCV-viremic PWH is low in the Netherlands, coinciding with widespread DAA-uptake. Barriers to DAA-uptake appear mostly patient-related, while HCV-transmission seems unlikely from the few DAA-untreated in care.
| Original language | English |
|---|---|
| Pages (from-to) | 773-783 |
| Number of pages | 11 |
| Journal | AIDS |
| Volume | 36 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - 1 May 2022 |
Bibliographical note
Funding Information:The ATHENA cohort is managed by Stichting HIV Monitoring and supported by a grant from the Dutch Ministry ofHealth, Welfare and Sport through the Centre for Infectious Disease Control of the National Institute for Public Health and the Environment. A complete list of ATHENA study group members can be found in the supplementary information, http://links.lww.com/QAD/C434 .
Funding Information:
C.I. has received research funding from Gilead, not related to this study. B.R. report a research grant from Gilead, outside the submitted work. R.A. reports fees paid from Janssen-Cilag, for advisory membership, outside the submitted work. P.R. reports grants and honoraria for advisory board participation from Gilead Sciences, ViiV Healthcare, and Merck, all paid to his institution and outside the submitted work. J.A. reports fees paid to the institution from Gilead, Janssen-Cilag, Abbvie, Bristol-Myers Squibb, and MSD for advisory membership, all outside the submitted work. M.vdV. reports grants and personal fees from Abbvie, Gilead, MSD, and ViiV Healthcare, all outside the submitted work. All other authors report no competing interests. No funding was received in order to prepare this manuscript.
Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
