Improving HCV cure rates in HIV-coinfected patients - a real-world perspective

Seetha Lakshmi, Maria Alcaide, Ana M. Palacio, Mohammed Shaikhomer, Abigail L. Alexander, Genevieve Gill-Wiehl, Aman Pandey, Kunal Patel, Dushyantha Jayaweera, Maria Del Pilar Hernandez

Research output: Contribution to journalArticle

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Abstract

OBJECTIVES: To study rates and predictors of hepatitis C virus (HCV) cure among human immunodeficiency virus (HIV)/HCV-coinfected patients, and then to evaluate the effect of attendance at clinic visits on HCV cure.

METHODS: Retrospective cohort study of adult HIV/HCV-coinfected patients who initiated and completed treatment for HCV with direct-acting antivirals (DAAs) between January 1, 2014, and June 30, 2015.

RESULTS: Eighty-four participants reported completing treatment. The median age was 58 years (interquartile ratio, 50-66); 88% were male and 50% were black. One-third were cirrhotic and half were HCV-treatment-experienced. The most commonly used regimen was sofosbuvir/ledipasvir (40%) followed by simeprevir/sofosbuvir (30%). Cure was achieved in 83.3%, 11.9% relapsed, and 2.3% experienced virological breakthrough. Two patients (2.3%) did not complete treatment based on pill counts and follow-up visit documentation. In multivariable analysis, cure was associated with attendance at follow-up clinic visits (odds ratio [OR], 9.0; 95% CI, 2.91-163) and with use of an integrase-based HIV regimen versus other non-integrase regimens, such as non-nucleoside analogues or protease inhibitors (OR, 6.22; 95% CI 1.81-141). Age, race, genotype, presence of cirrhosis, prior HCV treatment, HCV regimen, and pre-treatment CD4 counts were not associated with cure.

CONCLUSIONS: Real-world HCV cure rates with DAAs in HCV/HIV coinfection are lower than those seen in clinical trials. Cure is associated with attendance at follow-up clinic visits and with use of an integrase-based HIV regimen. Future studies should evaluate best antiretroviral regimens, predictors of attendance at follow-up visits, impact of different monitoring protocols on medication adherence, and interventions to ensure adequate models of HIV/HCV care.

Original languageEnglish (US)
Pages (from-to)SP198-SP204
JournalThe American journal of managed care
Volume22
Issue number6
StatePublished - May 1 2016

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Hepacivirus
HIV
Ambulatory Care
Integrases
Antiviral Agents
Therapeutics
Odds Ratio
Medication Adherence
CD4 Lymphocyte Count
Protease Inhibitors
Coinfection
Documentation
Fibrosis
Cohort Studies
Retrospective Studies
Genotype
Clinical Trials

ASJC Scopus subject areas

  • Health Policy

Cite this

Lakshmi, S., Alcaide, M., Palacio, A. M., Shaikhomer, M., Alexander, A. L., Gill-Wiehl, G., ... Del Pilar Hernandez, M. (2016). Improving HCV cure rates in HIV-coinfected patients - a real-world perspective. The American journal of managed care, 22(6), SP198-SP204.

Improving HCV cure rates in HIV-coinfected patients - a real-world perspective. / Lakshmi, Seetha; Alcaide, Maria; Palacio, Ana M.; Shaikhomer, Mohammed; Alexander, Abigail L.; Gill-Wiehl, Genevieve; Pandey, Aman; Patel, Kunal; Jayaweera, Dushyantha; Del Pilar Hernandez, Maria.

In: The American journal of managed care, Vol. 22, No. 6, 01.05.2016, p. SP198-SP204.

Research output: Contribution to journalArticle

Lakshmi, S, Alcaide, M, Palacio, AM, Shaikhomer, M, Alexander, AL, Gill-Wiehl, G, Pandey, A, Patel, K, Jayaweera, D & Del Pilar Hernandez, M 2016, 'Improving HCV cure rates in HIV-coinfected patients - a real-world perspective', The American journal of managed care, vol. 22, no. 6, pp. SP198-SP204.
Lakshmi S, Alcaide M, Palacio AM, Shaikhomer M, Alexander AL, Gill-Wiehl G et al. Improving HCV cure rates in HIV-coinfected patients - a real-world perspective. The American journal of managed care. 2016 May 1;22(6):SP198-SP204.
Lakshmi, Seetha ; Alcaide, Maria ; Palacio, Ana M. ; Shaikhomer, Mohammed ; Alexander, Abigail L. ; Gill-Wiehl, Genevieve ; Pandey, Aman ; Patel, Kunal ; Jayaweera, Dushyantha ; Del Pilar Hernandez, Maria. / Improving HCV cure rates in HIV-coinfected patients - a real-world perspective. In: The American journal of managed care. 2016 ; Vol. 22, No. 6. pp. SP198-SP204.
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abstract = "OBJECTIVES: To study rates and predictors of hepatitis C virus (HCV) cure among human immunodeficiency virus (HIV)/HCV-coinfected patients, and then to evaluate the effect of attendance at clinic visits on HCV cure.METHODS: Retrospective cohort study of adult HIV/HCV-coinfected patients who initiated and completed treatment for HCV with direct-acting antivirals (DAAs) between January 1, 2014, and June 30, 2015.RESULTS: Eighty-four participants reported completing treatment. The median age was 58 years (interquartile ratio, 50-66); 88{\%} were male and 50{\%} were black. One-third were cirrhotic and half were HCV-treatment-experienced. The most commonly used regimen was sofosbuvir/ledipasvir (40{\%}) followed by simeprevir/sofosbuvir (30{\%}). Cure was achieved in 83.3{\%}, 11.9{\%} relapsed, and 2.3{\%} experienced virological breakthrough. Two patients (2.3{\%}) did not complete treatment based on pill counts and follow-up visit documentation. In multivariable analysis, cure was associated with attendance at follow-up clinic visits (odds ratio [OR], 9.0; 95{\%} CI, 2.91-163) and with use of an integrase-based HIV regimen versus other non-integrase regimens, such as non-nucleoside analogues or protease inhibitors (OR, 6.22; 95{\%} CI 1.81-141). Age, race, genotype, presence of cirrhosis, prior HCV treatment, HCV regimen, and pre-treatment CD4 counts were not associated with cure.CONCLUSIONS: Real-world HCV cure rates with DAAs in HCV/HIV coinfection are lower than those seen in clinical trials. Cure is associated with attendance at follow-up clinic visits and with use of an integrase-based HIV regimen. Future studies should evaluate best antiretroviral regimens, predictors of attendance at follow-up visits, impact of different monitoring protocols on medication adherence, and interventions to ensure adequate models of HIV/HCV care.",
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AU - Shaikhomer, Mohammed

AU - Alexander, Abigail L.

AU - Gill-Wiehl, Genevieve

AU - Pandey, Aman

AU - Patel, Kunal

AU - Jayaweera, Dushyantha

AU - Del Pilar Hernandez, Maria

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