Successful implementation of hepatitis C virus treatment in two large HIV clinics in Amsterdam

Saris, Job; Berk, Guido van den; Moha, Daoud Ait; Meer, Jan van der; Brinkman, Kees; Valk, Marc van der

doi:10.1097/qad.0000000000001566

Cited by 4 publications

(1 citation statement)

References 2 publications

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“…[34][35][36][37] As providers are only one link in the care cascade, coordinated approaches are needed to prioritize and allocate resources for better outcomes. 31,32 This has led many countries to form national plans such as those in Spain, 38 Netherlands, 39,40 France, 41 European Union, 42 Australia, 43,44 and United States. 45 In many of these countries, recent efforts for universal DAA access has improved treatment uptake and HCV incidence/prevalence, even in co-infected populations.…”

Section: Discussionmentioning

confidence: 99%

Hepatitis C care cascade in HIV patients at an urban clinic in the early direct-acting antiviral era

Non

Amornsawadwattana

et al. 2019

Int J STD AIDS

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Guidelines advocate universal, prompt treatment of hepatitis C (HCV) infection in HIV/HCV co-infected patients, but barriers to uptake of HCV direct-acting antivirals (DAAs) remain unclear in this population. This retrospective study investigated the care cascade from HCV diagnosis to sustained virologic response (SVR) at an urban infectious disease clinic in Saint Louis, Missouri during the first 18 months of interferon-free DAA availability in the United States. Of 1949 HIV patients seen in clinic, 91.9% were screened for HCV and 5.4% (n = 106) had chronic HCV infection with follow-up. Of these 106 co-infected patients, 100 underwent fibrosis testing, 55 were offered DAAs, 38 completed treatment, and 37 achieved SVR. Delayed DAA treatment was associated with no insurance, substance abuse, poor HIV control, and younger age. Providers delayed DAA treatment most commonly for substance abuse, psychiatric disease, and uncontrolled HIV. Mean time to insurance decision from initial prescription was 20.9 ± 29.6 days and mean time to final decision was 29.9 ± 40.1 days. DAAs are highly successful in co-infected patients in this early period but insurance delays and misconceptions from the interferon era can ultimately limit uptake. Addressing these factors in a comprehensive treatment model may bridge disparities and improve real-world SVRs.

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Section: Discussionmentioning

confidence: 99%

Hepatitis C care cascade in HIV patients at an urban clinic in the early direct-acting antiviral era

Non

Amornsawadwattana

et al. 2019

Int J STD AIDS

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Linkage and retention in HCV care for HIV‐infected populations: early data from the DAA era

et al. 2018

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IntroductionThere is currently no published data on the effectiveness of DAA treatment for elimination of HCV infection in HIV‐infected populations at a population level. However, a number of relevant studies and initiatives are emerging. This research aims to report cascade of care data for emerging HCV elimination initiatives and studies that are currently being evaluated in HIV/HCV co‐infected populations in the context of implementation science theory.Methods HCV elimination initiatives and studies in HIV co‐infected populations that are currently underway were identified. Context, intervention characteristics and cascade of care data were synthesized in the context of implementation science frameworks.ResultsSeven HCV elimination initiatives and studies were identified in HIV co‐infected populations, mainly operating in high‐income countries. Four were focused mainly on HCV elimination in HIV‐infected gay and bisexual men (GBM), and three included a combination of people who inject drugs (PWID), GBM and other HIV‐infected populations. None were evaluating treatment delivery in incarcerated populations. Overall, HCV RNA was detected in 4894 HIV‐infected participants (range within studies: 297 to 994): 48% of these initiated HCV treatment (range: 21% to 85%; within studies from a period where DAAs were broadly available the total is 57%, range: 36% to 74%). Among studies with treatment completion data, 96% of 1109 initiating treatment completed treatment (range: 94% to 99%). Among those who could be assessed for sustained virological response at 12 weeks (SVR12), 1631 of 1757 attained SVR12 (93%, range: 86% to 98%).ConclusionsEarly results from emerging research on HCV elimination in HIV‐infected populations suggest that HCV treatment uptake is higher than reported levels prior to DAA treatment availability, but approximately half of patients remain untreated. These results are among diagnosed populations and additional effort is required to increase diagnosis rates. Among those who have initiated treatment, completion and SVR rates are promising. More data are required in order to evaluate the effectiveness of these elimination programmes in the long term, assess which intervention components are effective, and whether they need to be tailored to particular population groups.

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Eliminating HIV/HCV co-infection in gay and bisexual men: is it achievable through scaling up treatment?

Sacks‐Davis

Pedrana

Scott

et al. 2018

Expert Review of Anti-infective Therapy

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Broad availability of direct-acting antiviral therapy for hepatitis C virus (HCV) raises the possibility that HCV prevalence and incidence can be reduced through scaling-up treatment, leading to the elimination of HCV. High rates of linkage to HIV care among HIV-infected gay and bisexual men may facilitate high uptake of HCV treatment, possibly making HCV elimination more achievable in this group. Areas covered: This review covers HCV elimination in HIV-infected gay and bisexual men, including epidemiology, spontaneous clearance and long term sequelae in the absence of direct-acting antiviral therapy; direct-acting antiviral therapy uptake and effectiveness in this group; HCV reinfection following successful treatment; and areas for further research. Expert commentary: Early data from the direct-acting antiviral era suggest that treatment uptake is increasing among HIV infected GBM, and SVR rates are very promising. However, in order to sustain current treatment rates, additional interventions at the behavioral, physician, and structural levels may be required to increase HCV diagnosis, including prompt detection of HCV reinfection. Timely consideration of these issues is required to maximize the population-level impact of HCV direct-acting antiviral therapy. Potential HCV transmissions from HIV-uninfected GBM, across international borders, and from those who are not GBM also warrant consideration.

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Successful implementation of hepatitis C virus treatment in two large HIV clinics in Amsterdam

Cited by 4 publications

References 2 publications

Hepatitis C care cascade in HIV patients at an urban clinic in the early direct-acting antiviral era

Hepatitis C care cascade in HIV patients at an urban clinic in the early direct-acting antiviral era

Linkage and retention in HCV care for HIV‐infected populations: early data from the DAA era

Eliminating HIV/HCV co-infection in gay and bisexual men: is it achievable through scaling up treatment?

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