Author information
1Disease Elimination Program, Burnet Institute, Melbourne, Australia.
2School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
3Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia.
4School of Population and Global Health, University of Melbourne, Melbourne, Australia.
5Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands.
6The Kirby Institute UNSW, Sydney, Australia.
7St Vincent's Hospital, Sydney, Australia.
8Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, Montreal, Canada.
9Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France.
10Service de Maladies Infectieuses, Hôpital Saint-Antoine APHP, Paris, France.
11CHU Bordeaux, Service d'information médicale, Bordeaux, France.
12University of Bordeaux, INSERM, Bordeaux Population Health Research Centre U1219, CIC-EC, Bordeaux, France.
13INRIA SISTM Team, Talence, France.
14Université Paris Descartes, Service Maladies Infectieuses et Tropicales, AP-HP, Hôpital Cochin, Paris, France.
15Department of Infectious Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.
16Amsterdam Infection & Immunity Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
17Stichting HIV Monitoring, Amsterdam, The Netherlands.
18Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain.
19Infectious Diseases, Hospital General Universitario Gregorio Marañón (IsSGM), Madrid, Spain.
20Instituto de Salud Carlos III, Madrid, Spain.
21Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
22Doherty Institute and School of Population and Global Health, University of Melbourne, Melbourne, Australia.
Abstract
Background: Historically, hepatitis C virus (HCV) was difficult to treat among people with HIV. However, treatment with direct-acting antivirals (DAAs) results in 90%-95% of people being cured. There is a need to understand why a proportion of people are not cured. We aimed to examine characteristics that may indicate an increased probability of unsuccessful DAA HCV treatment.
Methods: Data were from the International Collaboration on Hepatitis C Elimination in HIV Cohorts. People who commenced DAA HCV treatment between 2014 and 2019 were included. Unsuccessful treatment was defined as a positive HCV RNA test at a person's first RNA test at least 4 weeks (SVR4+) following the end of treatment. Multivariable mixed-effects logistic regression was used to examine characteristics associated with unsuccessful treatment.
Results: Of 4468 people who commenced DAA treatment, 4098 (91.7%) had an SVR test 4+ weeks following the end of treatment, 207 (5%) of whom were unsuccessfully treated. Compared to a CD4+ cell count > 500 cells/mm3, cell counts < 200 (aOR 1.81, 95%CI 1.00-3.29) and between 200 and 349 (aOR 1.95, 95%CI 1.30-2.93) were associated with increased odds of unsuccessful treatment. Among 1921 people with data on injection drug use in the 12 months prior to treatment, there was some evidence that recent injection drug use was associated with increased odds of unsuccessful treatment; however, this was not statistically significant (aOR 1.67, 95%CI 0.99-2.82).
Conclusions: The overwhelming majority of people were successfully treated for HCV. Overall, 5% of those with an SVR4+ test were unsuccessfully treated; this was more likely among people with evidence of immunodeficiency and those who reported recently injecting drugs.