Abstract
Original language | English |
---|---|
Pages (from-to) | e294-e304 |
Journal | The Lancet. Public health |
Volume | 8 |
Issue number | 4 |
DOIs | |
Publication status | Published - 1 Apr 2023 |
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In: The Lancet. Public health, Vol. 8, No. 4, 01.04.2023, p. e294-e304.
Research output: Contribution to journal › Article › Academic › peer-review
TY - JOUR
T1 - Reasons for not commencing direct-acting antiviral treatment despite unrestricted access for individuals with HIV and hepatitis C virus
T2 - a multinational, prospective cohort study
AU - Isfordink, Cas J.
AU - Boyd, Anders
AU - Sacks-Davis, Rachel
AU - van Santen, Daniela K.
AU - Smit, Colette
AU - Martinello, Marianne
AU - Stoove, Mark
AU - Berenguer, Juan
AU - Wittkop, Linda
AU - Klein, Marina B.
AU - Rauch, Andri
AU - Salmon, Dominique
AU - Lacombe, Karine
AU - Stewart, Ashleigh
AU - Schinkel, Janke
AU - InCHEHC study group
AU - Doyle, Joseph S.
AU - Hellard, Margaret
AU - van der Valk, Marc
AU - Matthews, Gail V.
N1 - Funding Information: We thank the study participants for their contribution to the research. We acknowledge the contribution of the ACCESS team members and ACCESS advisory committee members who are not coauthors of this article. We also acknowledge all clinical services participating in ACCESS. The list of ACCESS team members, ACCESS advisory committee members, and participating ACCESS services can be found on the ACCESS website (https://accessproject.org.au). ACCESS is a partnership between the Burnet Institute, Kirby Institute, and National Reference Laboratory. We thank all clinicians and clinical research technicians participating in the ANRS CO 13 HEPAVIH Cohort sponsored and funded by Inserm-ANRS and the members of its scientific committee (website: https://www.anrs.fr/fr/biobanque/760/anrs-co13-hepavih). The ATHENA database is maintained by Stichting HIV Monitoring and supported by a grant from the Dutch Ministry of Health, Welfare, and Sport through the Centre for Infectious Disease Control of the National Institute for Public Health and the Environmenta (https://www.hiv-monitoring.nl/en/research-using-our-data/submit-research-proposal/rules-acknowledgement). We acknowledge the contribution of the Canadian Co-infection Cohort participants, site investigators, and team members (http://www.cocostudy.ca). The Canadian Co-infection Cohort is supported by the Fonds de Recherche du Québec-Santé; Réseau Sida/Maladies Infectieuses, the Canadian Institute for Health Research (CIHR; FDN-143270); and the CIHR Canadian HIV Trials Network (CTN222). We acknowledge the contribution of the CEASE team members and CEASE protocol steering committee members who are not coauthors of this article. We also acknowledge the clinical services participating in CEASE. Data for CEASE are gathered from 12 primary care services and two tertiary health services. The list of CEASE team members and collaborative partners can be found on the CEASE website (https://kirby.unsw.edu.au/project/control-and-elimination-within-australia-hepatitis-c-people-living-hiv-cease). The CEASE study was supported by Gilead Sciences and the Australian Government Department of Health and Ageing. We acknowledge the contribution of the Swiss HIV Cohort Study participants and team members (https://shcs.ch/184-for-shcs-publications). This study has been financed within the framework of the Swiss HIV Cohort Study, supported by the Swiss National Science Foundation (grant number 201369) and by the Swiss HIV Cohort Study research foundation. Data from the Swiss HIV Cohort Study are gathered by the five Swiss University Hospitals, two Cantonal Hospitals, 15 affiliated hospitals, and 36 private physicians (listed in http://www.shcs.ch/180-health-care-providers). We thank all clinicians and clinical research technicians participating in the SAIDCC database of the Infectious Diseases Unit of St Antoine Hospital, AP-HP, Paris, France. We acknowledge the contribution of the AQUITAINE (ANRS CO3 AQUITAINE/AquiVIH-NA) members and their participants (https://aquivih-na.fr/). We acknowledge the contribution of the CoRIS steering committee members and their participants. The InCHEHC cohort was funded by the Australian Government National Health and Medical Research Council (grant number GNT1132902). Funding Information: We thank the study participants for their contribution to the research. We acknowledge the contribution of the ACCESS team members and ACCESS advisory committee members who are not coauthors of this article. We also acknowledge all clinical services participating in ACCESS. The list of ACCESS team members, ACCESS advisory committee members, and participating ACCESS services can be found on the ACCESS website ( https://accessproject.org.au ). ACCESS is a partnership between the Burnet Institute, Kirby Institute, and National Reference Laboratory. We thank all clinicians and clinical research technicians participating in the ANRS CO 13 HEPAVIH Cohort sponsored and funded by Inserm-ANRS and the members of its scientific committee (website: https://www.anrs.fr/fr/biobanque/760/anrs-co13-hepavih ). The ATHENA database is maintained by Stichting HIV Monitoring and supported by a grant from the Dutch Ministry of Health, Welfare, and Sport through the Centre for Infectious Disease Control of the National Institute for Public Health and the Environment ( https://www.hiv-monitoring.nl/en/research-using-our-data/submit-research-proposal/rules-acknowledgement ). We acknowledge the contribution of the Canadian Co-infection Cohort participants, site investigators, and team members ( http://www.cocostudy.ca ). The Canadian Co-infection Cohort is supported by the Fonds de Recherche du Québec-Santé; Réseau Sida/Maladies Infectieuses, the Canadian Institute for Health Research (CIHR; FDN-143270); and the CIHR Canadian HIV Trials Network (CTN222). We acknowledge the contribution of the CEASE team members and CEASE protocol steering committee members who are not coauthors of this article. We also acknowledge the clinical services participating in CEASE. Data for CEASE are gathered from 12 primary care services and two tertiary health services. The list of CEASE team members and collaborative partners can be found on the CEASE website ( https://kirby.unsw.edu.au/project/control-and-elimination-within-australia-hepatitis-c-people-living-hiv-cease ). The CEASE study was supported by Gilead Sciences and the Australian Government Department of Health and Ageing. We acknowledge the contribution of the Swiss HIV Cohort Study participants and team members ( https://shcs.ch/184-for-shcs-publications ). This study has been financed within the framework of the Swiss HIV Cohort Study, supported by the Swiss National Science Foundation (grant number 201369) and by the Swiss HIV Cohort Study research foundation. Data from the Swiss HIV Cohort Study are gathered by the five Swiss University Hospitals, two Cantonal Hospitals, 15 affiliated hospitals, and 36 private physicians (listed in http://www.shcs.ch/180-health-care-providers ). We thank all clinicians and clinical research technicians participating in the SAIDCC database of the Infectious Diseases Unit of St Antoine Hospital, AP-HP, Paris, France. We acknowledge the contribution of the AQUITAINE (ANRS CO3 AQUITAINE/AquiVIH-NA) members and their participants ( https://aquivih-na.fr/ ). We acknowledge the contribution of the CoRIS steering committee members and their participants. The InCHEHC cohort was funded by the Australian Government National Health and Medical Research Council (grant number GNT1132902). Publisher Copyright: © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license.
PY - 2023/4/1
Y1 - 2023/4/1
N2 - Background: Individuals with HIV and hepatitis C virus (HCV) who remain untreated with direct-acting antivirals can contribute to HCV transmission and HCV-related mortality. We aimed to compare rates of uptake of direct-acting antivirals following unrestricted access to this treatment in high-income countries and examine factors associated with remaining untreated. Methods: This multinational, prospective cohort study used data from the International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC). We analysed data from nine observational cohorts participating in the InCHEHC, including data from six high-income countries (Australia, Canada, France, the Netherlands, Spain, and Switzerland). We included individuals aged 18 years and older, with HIV and HCV (ie, HCV-RNA positive without evidence of spontaneous clearance) during unrestricted access to interferon-free direct-acting antiviral treatment in each country. We calculated the cumulative proportion of participants who remained untreated with direct-acting antivirals, with follow-up starting after the date of unrestricted access or cohort inclusion, whichever occurred most recently. Factors associated with the commencement rate of direct-acting antiviral treatment were assessed using competing-risks regression with the Fine-Gray method. Findings: The date of unrestricted access to direct-acting antiviral treatment for people with HIV ranged from Nov 1, 2014, in France to Nov 1, 2017, in Switzerland. We included 4552 individuals with HIV–HCV, mainly men who have sex with men (MSM; n=2156 [47%]) and people who inject or have injected drugs (n=1453 [32%]). 1365 (30%) of 4552 participants remained untreated with direct-acting antivirals. For individuals treated with direct-acting antivirals, median time from start of follow-up to treatment was 5 months (IQR 2–12). For individuals who were not treated with direct-acting antivirals, median follow-up was 22 months (8–30). Being linked to care in Australia, France, or the Netherlands, on antiretroviral therapy, having undetectable HIV RNA, and shorter duration since first positive HCV test were independently associated with higher commencement rate of direct-acting antiviral treatment. Compared with MSM, male heterosexuals and females with unknown or other routes of HIV transmission (ie, neither injection drug use nor heterosexual transmission) had lower rates of commencement. Interpretation: Despite unrestricted access, almost a third of individuals with HIV–HCV remained untreated with direct-acting antivirals during follow-up, with variation in commencement rate of HCV treatment between countries and key populations. Increased efforts are required to reach the remaining individuals with HIV who are HCV-viraemic to achieve HIV–HCV micro-elimination. Funding: None.
AB - Background: Individuals with HIV and hepatitis C virus (HCV) who remain untreated with direct-acting antivirals can contribute to HCV transmission and HCV-related mortality. We aimed to compare rates of uptake of direct-acting antivirals following unrestricted access to this treatment in high-income countries and examine factors associated with remaining untreated. Methods: This multinational, prospective cohort study used data from the International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC). We analysed data from nine observational cohorts participating in the InCHEHC, including data from six high-income countries (Australia, Canada, France, the Netherlands, Spain, and Switzerland). We included individuals aged 18 years and older, with HIV and HCV (ie, HCV-RNA positive without evidence of spontaneous clearance) during unrestricted access to interferon-free direct-acting antiviral treatment in each country. We calculated the cumulative proportion of participants who remained untreated with direct-acting antivirals, with follow-up starting after the date of unrestricted access or cohort inclusion, whichever occurred most recently. Factors associated with the commencement rate of direct-acting antiviral treatment were assessed using competing-risks regression with the Fine-Gray method. Findings: The date of unrestricted access to direct-acting antiviral treatment for people with HIV ranged from Nov 1, 2014, in France to Nov 1, 2017, in Switzerland. We included 4552 individuals with HIV–HCV, mainly men who have sex with men (MSM; n=2156 [47%]) and people who inject or have injected drugs (n=1453 [32%]). 1365 (30%) of 4552 participants remained untreated with direct-acting antivirals. For individuals treated with direct-acting antivirals, median time from start of follow-up to treatment was 5 months (IQR 2–12). For individuals who were not treated with direct-acting antivirals, median follow-up was 22 months (8–30). Being linked to care in Australia, France, or the Netherlands, on antiretroviral therapy, having undetectable HIV RNA, and shorter duration since first positive HCV test were independently associated with higher commencement rate of direct-acting antiviral treatment. Compared with MSM, male heterosexuals and females with unknown or other routes of HIV transmission (ie, neither injection drug use nor heterosexual transmission) had lower rates of commencement. Interpretation: Despite unrestricted access, almost a third of individuals with HIV–HCV remained untreated with direct-acting antivirals during follow-up, with variation in commencement rate of HCV treatment between countries and key populations. Increased efforts are required to reach the remaining individuals with HIV who are HCV-viraemic to achieve HIV–HCV micro-elimination. Funding: None.
UR - http://www.scopus.com/inward/record.url?scp=85150787133&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/S2468-2667(23)00056-7
DO - https://doi.org/10.1016/S2468-2667(23)00056-7
M3 - Article
C2 - 36965984
SN - 2468-2667
VL - 8
SP - e294-e304
JO - The Lancet. Public health
JF - The Lancet. Public health
IS - 4
ER -