High treatment uptake in HIV/HCV-coinfected patients after unrestricted access to direct-acting antivirals in the Netherlands

Abstract

Background

The Netherlands has provided unrestricted access to direct-acting antivirals (DAAs) since November 2015. We analyzed the nationwide HCV treatment uptake among HIV/HCV-coinfected patients.

Methods

Data were obtained from the ATHENA HIV observational cohort in which >98% of HIV-infected patients ever registered since 1998 are included. Patients were included if they ever had 1 positive HCV RNA, did not spontaneously clear and were known to still be in care. Treatment uptake and outcome were assessed. When patients were treated more than once, only data of the most recent treatment episode were included. Data were updated until February 2017. In addition, each treatment center was queried in April 2017 for a data update on DAA treatment and achieved SVR.

Results

Of 23,574 HIV-infected patients ever linked to care, 1471 HCV-coinfected patients (69% men who have sex with men (MSM), 15% people who (formerly) inject drugs and 15% another HIV transmission route) fulfilled the inclusion criteria. Eighty-seven percent (1284/1471) had ever initiated HCV treatment between 2000 and 2017, 76% (1124/1471) were cured and in 6% (92/1471) DAA treatment results were pending. Among MSM 83% (844/1022) were cured and in 6% (66/1022) DAA treatment results were pending. Overall 187 patients had never initiated treatment, 14 patients failed DAAs and 54 patients failed a pegylated-interferon-alpha based regimen.

Conclusion

Fifteen months after unrestricted DAA availability the majority of HIV/HCV-coinfected patients in the Netherlands are cured (76%) or awaiting DAA treatment results (6%). This rapid treatment scale-up may contribute to future HCV elimination among these patients.