Access and response to direct antiviral agents DAA in HIV-HCV co-infected patients in Italy: Data from the Icona cohortReport as inadecuate




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Background

Real-life data on access and response to direct antiviral agents DAA in HIV-HCV coinfected individuals are lacking.

Methods

HCV viremic, HIV-positive patients from Icona and Hepaicona cohorts naïve to DAA by January 2013 were included. Access and predictors of starting DAA were evaluated. Switches of antiretroviral drugs at starting DAA were described. We calculated sustained virological response SVR12 in those reaching 12 weeks after end-of-treatment EOT, and defined treatment failure TF as discontinuation of DAA before EOT or non-SVR12. Statistical analyses included Kaplan-Meier curves, univariable and multivariable analyses evaluating predictors of access to DAA and of treatment outcome non-SVR and TF.

Results

2,607 patients included. During a median follow-up of 38 IQR:30–41 months, 920 35.3% patients started DAA. Eligibility for reimbursement was the strongest predictor to access to treatment: 761-1,090 69.8% eligible and 159-1,517 10.5% non-eligible to DAA reimbursement. Older age, HIV-RNA≤50 copies-mL were associated to faster DAA initiation, higher CD4 count and HCV-genotype 3 with delayed DAA initiation in those eligible to DAA reimbursement. Up to 28% of patients 36% of those on ritonavir-boosted protease inhibitors, PI-r underwent antiretroviral ART modification at DAA initiation. 545-595 91.6% patients reaching EOT achieved SVR12. Overall, TF occurred in 61-606 patients 10.1%, with 11 discontinuing DAA before EOT. Suboptimal DAA was the only independent predictor of both non-SVR12 AHR 2.52, 95%CI:1.24–5.12 and TF AHR: 2.19; 95%CI:1.13–4.22.

Conclusions

Only 35.3% had access to HCV treatment. Despite excellent rates of SVR12 rates 91.6%, only 21% 545-2,607 of our HIV-HCV co-infected patients are cured.



Author: Antonella d-Arminio Monforte , Alessandro Cozzi-Lepri, Francesca Ceccherini-Silberstein, Andrea De Luca, Sergio Lo Caputo, Antone

Source: http://plos.srce.hr/



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