1. Effectiveness of Direct-Acting Antiviral Therapy in Patients With Human Immunodeficiency Virus-Hepatitis C Virus Coinfection in Routine Clinical Care: A Multicenter Study.
- Author
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Kim, H Nina, Nance, Robin M, Williams-Nguyen, Jessica S, Chris Delaney, JA, Crane, Heidi M, Cachay, Edward R, Martin, Jeffrey, Mathews, W Christopher, Chander, Geetanjali, Franco, Ricardo, Hurt, Christopher B, Geng, Elvin H, Rodriguez, Benigno, Moore, Richard D, Saag, Michael S, Kitahata, Mari M, and Centers for AIDS Research Network of Integrated Clinical Systems
- Subjects
Centers for AIDS Research Network of Integrated Clinical Systems ,HIV ,direct-acting antiviral ,hepatitis C virus ,HIV/AIDS ,Liver Disease ,Infectious Diseases ,Hepatitis - C ,Chronic Liver Disease and Cirrhosis ,Drug Abuse (NIDA Only) ,Substance Abuse ,Clinical Research ,Clinical Trials and Supportive Activities ,Brain Disorders ,Hepatitis ,Mental Health ,Emerging Infectious Diseases ,Digestive Diseases ,6.1 Pharmaceuticals ,Infection ,Mental health - Abstract
BackgroundDirect-acting antiviral (DAA) therapy have been shown to be highly successful in clinical trials and observational studies, but less is known about treatment success in patients with a high burden of comorbid conditions, including mental health and substance use disorders. We evaluated DAA effectiveness across a broad spectrum of patients with human immunodeficiency virus (HIV)-hepatitis C virus (HCV) coinfection in routine clinical care, including those with psychosocial comorbid conditions.MethodsThe primary end point was sustained virologic response (SVR), defined as HCV RNA not detected or 3.25) was present in 24%, and 17% were interferon treatment experienced; 96% had genotype 1 infection and 432 (81%) had received ledipasvir-sofosbuvir. SVR occurred in 96.5% (95% CI, 94.5%-97.9%). Patients who were black, treatment experienced, or cirrhotic all had SVR rates >95%. Patients with depression and/or anxiety, psychotic disorder, illicit drug use, or alcohol use disorder also had high SVR rates, ranging from 95.4% to 96.8%. The only factor associated with lower SVR rate was early discontinuation (77.8%; 95% CI, 52.4%-93.6%). Similar results were seen in multiply imputed data sets.ConclusionsOur study represents a large multicenter examination of DAA therapy in HIV/HCV-coinfected patients. The broad treatment success we observed across this diverse group of patients with significant comorbid conditions is highly affirming and argues for widespread implementation of DAA therapy.
- Published
- 2019