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Parenteral drug use as the main barrier to hepatitis C treatment uptake in HIV-infected patients

AuthorsRivero-Juárez, Antonio; Téllez, Francisco; Castaño‐Carracedo, M.; Merino, Dolores; Espinosa, Nuria; Santos, Jesús; Macias, Juan; Paniagua-García, María; Zapata‐Lopez, A.; Collado, Antonio; Gómez-Vidal, María Amparo; Perez‐Stachowski, J.; Muñoz‐Medina, L.; Fernandez‐Fuertes, E.; Rivero, Antonio
KeywordsBarrier to treatment
Direct‐acting antiviral treatment
Hepatitis C virus
Opioid substitution therapy
People who inject drugs
Issue DateJul-2019
PublisherJohn Wiley & Sons
CitationHIV Medicine 20(6): 359-367 (2019)
Abstract[Objectives]: Our objective was to identify patient factors associated with being untreated for hepatitis C virus (HCV) infection in HIV-coinfected patients.
[Methods]: A prospective longitudinal study was carried out. HIV-infected patients with active chronic HCV infection included in the HERACLES cohort (NCT02511496) constituted the study population. The main study outcome was receipt of HCV direct-acting antiviral (DAA) treatment from 1 May 2015 to 1 May 2017. The population was divided into patients who were receiving HCV treatment during follow-up and those who were not.
[Results]: Of the 15 556 HIV-infected patients in care, 3075 (19.7%) presented with chronic HCV infection and constituted the study population. At the end of the follow-up, 1957 patients initiated HCV therapy (63.6%). Age < 50 years, absence of or minimal liver fibrosis, being treatment-naïve, HCV genotype 3 infection, being in the category of people who inject drugs using opioid substitutive therapy (OST-PWID), and being in the category of recent PWID were identified as significant independent risk factors associated with low odds of DAA implementation. When a multivariate analysis was performed including only the PWID population, both OST-PWID [odds ratio (OR) 0.552; 95% confidence interval (CI) 0.409–0.746) and recent PWID (OR 0.019; 95% CI 0.004–0.087) were identified as independent factors associated with low odds of treatment implementation.
[Conclusions]: We identified factors, which did not include prioritization of a DAA uptake strategy, that limited access to HCV therapy. The low treatment uptake in several populations seriously jeopardizes the elimination of HCV infection in the coming years.
Publisher version (URL)http://dx.doi.org/10.1111/hiv.12715
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