Time to direct-acting antivirals initiation and liver-related events in people with HIV and Hepatitis C virus.

IF 3.4 2区医学 Q3 IMMUNOLOGY

AIDS Pub Date : 2025-02-19 DOI:10.1097/QAD.0000000000004161

Mathieu Chalouni, Daniela K Van Santen, Juan Berenguer, Inmaculada Jarrin, José M Miro, Marina B Klein, Jim Young, Jessie Torgersen, Christopher T Rentsch, M John Gill, Rachel L Epstein, Benjamin Linas, Robert Zangerle, Bernard Surial, Andri Rauch, Giota Touloumi, Antonios Papadopoulos, Linda Wittkop, Marc Van Der Valk, Anders Boyd, Antonella d'Arminio Monforte, Massimo Puoti, Roger W Logan, Sophia M Rein, Miguel A Hernán, Sara Lodi

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引用次数: 0

Abstract

Objective: People with HIV-HCV co-infection need antiretroviral treatment (ART) to suppress HIV and direct-acting antivirals (DAAs) to cure HCV. ART is typically prioritized, but delays in DAA initiation may increase the risk of liver-related events and HCV transmission to others.

Design: Target trial emulation with observational data collected in routine clinical practice from a collaboration of cohorts from Europe and North America.

Methods: We included DAA-naïve adults with HIV-HCV co-infection who achieved HIV virologic suppression (HIV RNA<50 copies/mL) after starting ART between 2013-2020. We 1) estimated the probability of not initiating DAAs at 6 and 36 months after HIV virologic suppression, and 2) emulated a target trial of early (≤6 months after HIV virological suppression) versus delayed (>6 months) DAA initiation and the 36-month risk of liver-related events (liver decompensation or hepatocellular carcinoma).

Results: Of 862 eligible individuals (median age 46 years; interquartile range 36 to 56), 14% were women, and 52% had a history of injection drug use. The 6 and 36-month probabilities of not initiating DAA were 58% (95% CI: 55, 61) and 24% (21, 27), respectively. The 36-month risk of liver-related events was 1.1% (0.4, 2.0) for early initiation and 1.7% (0.7, 2.5) for delayed initiation; risk difference -0.5% (-1.2, 0.4).

Conclusions: Almost one-quarter of people with HIV-HCV co-infection on ART had not initiated DAA 3 years after HIV virologic suppression. Because the 3-year risk of liver-related events was low, estimates of the impact of delayed DAA initiation were imprecise.

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来源期刊

AIDS 医学-病毒学

CiteScore

5.90

自引率

5.30%

发文量

478

审稿时长

3 months

期刊介绍： Publishing the very latest ground breaking research on HIV and AIDS. Read by all the top clinicians and researchers, AIDS has the highest impact of all AIDS-related journals. With 18 issues per year, AIDS guarantees the authoritative presentation of significant advances. The Editors, themselves noted international experts who know the demands of your work, are committed to making AIDS the most distinguished and innovative journal in the field. Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.