Effects of direct-acting antiviral treatment on reducing mortality among Medicare beneficiaries with HIV and HCV coinfection

Yin, Xin; Kong, Lan; Du, Ping; Jung, Jeah

doi:10.1080/09540121.2021.1981221

Cited by 5 publications

(6 citation statements)

References 34 publications

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“…Although factors other than access to effective HCV treatment (e.g. the introduction of effective antiretroviral therapy for HIV and hepatitis B) may have contributed to our findings, they are consistent with several reports from other high‐income countries that showed improved liver‐ and non‐liver‐related outcomes with second‐generation DAA treatments among persons with HIV/HCV coinfection 15,31,32 . A study from the United States estimated a risk difference for mortality of −3.8% for persons treated with DAAs 31 .…”

Section: Discussionsupporting

confidence: 91%

“…the introduction of effective antiretroviral therapy for HIV and hepatitis B) may have contributed to our findings, they are consistent with several reports from other high-income countries that showed improved liver-and non-liver-related outcomes with second-generation DAA treatments among persons with HIV/HCV coinfection. 15,31,32 A study from the United States estimated a risk difference for mortality of −3.8% for persons treated with DAAs. 31 In the ART-CC collaboration, persons who reached SVR shortly after HCV infection were not at higher risk of overall mortality compared to PWH without HCV infection.…”

Section: Replicating Infectionmentioning

confidence: 99%

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Long‐term trends in hepatitis C prevalence, treatment uptake and liver‐related events in the Swiss HIV Cohort Study

Baumann,

Braun,

Cavassini

et al. 2023

Liver International

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Background and AimsTreatment for chronic hepatitis C virus (HCV) infections changed dramatically in the last decade. We assessed changes in the prevalence of replicating HCV infection, treatment uptake and liver‐related morbidity and mortality in persons with HIV (PWH) and hepatitis C in the Swiss HIV cohort study.MethodsWe included all cohort participants between 2002 and 2021. We assessed yearly prevalence of replicating HCV infection, overall and liver‐related mortality, as well as the yearly incidence of liver‐related events in persons with at least one documented positive HCV‐RNA.ResultsOf 14 652 participants under follow‐up, 2294 had at least one positive HCV‐RNA measurement. Of those, 1316 (57%) ever received an HCV treatment. Treatment uptake increased from 8.1% in 2002 to a maximum of 32.6% in 2016. Overall, prevalence of replicating HCV infection declined from 16.5% in 2004 to 1.3% in 2021. HCV prevalence declined from 63.2% to 7.1% in persons who inject drugs, and from 4.1% to 0.6% in men who have sex with men. Among the 2294 persons with replicating HCV infection, overall mortality declined from a maximum of 3.3 per 100 patient‐years (PY) to 1.1 per 100 PY, and incidence of liver‐related events decreased from 1.4/100 PY to 0.2/100 PY.ConclusionsThe introduction of DAA therapy was associated with a more than 10‐fold reduction in prevalence of replicating HCV infection in PWH, approaching the estimates in the general population. Overall mortality and liver‐related events declined substantially in persons living with HIV and hepatitis C.

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Section: Discussionsupporting

confidence: 91%

Section: Replicating Infectionmentioning

confidence: 99%

Long‐term trends in hepatitis C prevalence, treatment uptake and liver‐related events in the Swiss HIV Cohort Study

Baumann,

Braun,

Cavassini

et al. 2023

Liver International

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“…This, combined with a median follow-up of 3.7 and 3.3 years for G1 and G2, respectively, permitted the observation of a sufficient number of events in both groups. Moreover, our population is comparable to other major European and American cohorts and population-based studies: [27,28] The EUROSIDA study reported 74% of males, a median age of 56 years, 27.8% of prior AIDS diagnosis, and 8% of cirrhosis in 1178 participants with HIV/HCV from Western European countries [27]. Similarly, a U.S.-based study including 1346 Medicare beneficiaries with HIV/HCV and who were DAA treated had 87.5% men, a median age of 56 years, and 7.3% participants with cirrhosis [28].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, our population is comparable to other major European and American cohorts and population-based studies: [27,28] The EUROSIDA study reported 74% of males, a median age of 56 years, 27.8% of prior AIDS diagnosis, and 8% of cirrhosis in 1178 participants with HIV/HCV from Western European countries [27]. Similarly, a U.S.-based study including 1346 Medicare beneficiaries with HIV/HCV and who were DAA treated had 87.5% men, a median age of 56 years, and 7.3% participants with cirrhosis [28]. These findings give us greater confidence in the generalization of results for the HIV/HCV and DAA-cured population globally.…”

Section: Discussionmentioning

confidence: 99%

Mortality in hepatitis C virus-cured vs. hepatitis C virus-uninfected people with HIV

Requena

Grabar

Lanoy

et al. 2023

Aids

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Objective: It is unknown whether hepatitis C virus (HCV)-cured people with HIV (PWH) without cirrhosis reached the same mortality risk as HCV-uninfected PWH. We aimed to compare mortality in PWH cured of HCV by direct-acting antivirals (DAAs) to mortality in individuals with HIV monoinfection.Design: Nationwide hospital cohort.Methods: HIV-controlled participants without cirrhosis and HCV-cured by DAAs started between September 2013 and September 2020, were matched on age (AE5 years), sex, HIV transmission group, AIDS status, and body mass index (BMI) (AE1 kg/m 2 ) to up to 10 participants with a virally suppressed HIV monoinfection followed at the time of HCV cure AE6 months. Poisson regression models with robust variance estimates were used to compare mortality in both groups after adjusting for confounders.Results: The analysis included 3961 HCV-cured PWH (G1) and 33 872 HCV-uninfected PWH (G2). Median follow-up was 3.7 years in G1 [interquartile range (IQR): 2.0-4.6], and 3.3 years (IQR: 1.7-4.4) in G2. Median age was 52.0 years (IQR: 47.0-56.0), and 29 116 (77.0%) were men. There were 150 deaths in G1 [adjusted incidence rate (aIR): 12.2/ 1000 person-years] and 509 (aIR: 6.3/1000 person-years) in G2, with an incidence rate ratio (IRR): 1.9 [95% confidence interval (CI), 1.4-2.7]. The risk remained elevated 12 months post HCV cure (IRR: 2.4 [95% CI, 1.6-3.5]). Non-AIDS/non-liver-related malignancy was the most common cause of death in G1 (28 deaths).Conclusions: Despite HCV cure and HIV viral suppression, after controlling on factors related to mortality, DAA-cured PWH without cirrhosis remain at higher risk of allcause mortality than people with HIV monoinfection. A better understanding of the determinants of mortality is needed in this population.

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“…After controlling for other risk factors, sustained virological response (interferon-based (IFN) or direct-acting antiviral (DAA)) significantly reduced the risk of all acute cardiovascular outcomes, particularly among female patients [ 65 ]. DAA treatment has also been associated with a smaller reduction in all-cause mortality for females (aHR, 0.50 (95% CI, 0.30–0.85)) compared with males (aHR, 0.34 (95% CI, 0.25–0.46)) [ 66 ].…”

Section: Sex and Gender Differences In Chronic Liver Diseases And T2dmentioning

confidence: 99%

Impact of Sex and Gender on Clinical Management of Patients with Advanced Chronic Liver Disease and Type 2 Diabetes

Licata

Russo

Giandalia

et al. 2023

JPM

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Gender differences in the epidemiology, pathophysiological mechanisms and clinical features in chronic liver diseases that may be associated with type 2 diabetes (T2D) have been increasingly reported in recent years. This sexual dimorphism is due to a complex interaction between sex- and gender-related factors, including biological, hormonal, psychological and socio-cultural variables. However, the impact of sex and gender on the management of T2D subjects with liver disease is still unclear. In this regard, sex-related differences deserve careful consideration in pharmacology, aimed at improving drug safety and optimising medical therapy, both in men and women with T2D; moreover, low adherence to and persistence of long-term drug treatment is more common among women. A better understanding of sex- and gender-related differences in this field would provide an opportunity for a tailored diagnostic and therapeutic approach to the management of T2D subjects with chronic liver disease. In this narrative review, we summarized available data on sex- and gender-related differences in chronic liver disease, including metabolic, autoimmune, alcoholic and virus-related forms and their potential evolution towards cirrhosis and/or hepatocarcinoma in T2D subjects, to support their appropriate and personalized clinical management.

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Effects of direct-acting antiviral treatment on reducing mortality among Medicare beneficiaries with HIV and HCV coinfection

Cited by 5 publications

References 34 publications

Long‐term trends in hepatitis C prevalence, treatment uptake and liver‐related events in the Swiss HIV Cohort Study

Long‐term trends in hepatitis C prevalence, treatment uptake and liver‐related events in the Swiss HIV Cohort Study

Mortality in hepatitis C virus-cured vs. hepatitis C virus-uninfected people with HIV

Impact of Sex and Gender on Clinical Management of Patients with Advanced Chronic Liver Disease and Type 2 Diabetes

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