title: Temporal changes and regional differences in treatment uptake of hepatitis C therapy in EuroSIDA.
abstract: OBJECTIVE
  All HIV/hepatitis C virus (HCV)-coinfected patients with chronic HCV infection and ≥ F2 fibrosis should be considered for HCV therapy. This study aimed to determine the rate of HCV treatment uptake among coinfected patients in Europe.
  
  
  METHODS
  EuroSIDA patients with viraemic HCV infection were included in the study. Poisson regression was used to identify temporal changes and regional differences in HCV treatment uptake.
  
  
  RESULTS
  A total of 1984 patients were included in the study, with a median follow-up time of 168 months [interquartile range (IQR) 121-204 months]. To date, 501 (25.3%) HIV/HCV-coinfected patients have received HCV therapy. Treatment incidence rose from 0.33 [95% confidence interval (CI) 0.16-0.50] per 100 person-years of follow-up (PYFU) in 1998 to 5.93 (95% CI 4.49-7.38) in 2007, falling to 3.78 (95% CI 2.50-5.07) in 2009. After adjustment, CD4 cell count > 350 cells/μL [incidence rate ratio (IRR) 1.33 (95% CI 1.06-1.67) vs. CD4 count 200-350 cells/μL] and ≥F2 liver fibrosis [IRR 1.60 (95% CI 1.14-2.25; P = 0.0065) vs. < F2 fibrosis] were predictors of anti-HCV treatment initiation. However, 22% of patients who remain untreated for HCV, with fibrosis data available, had ≥F2 fibrosis and should have been considered for treatment, while only 36% of treated patients had ≥F2 fibrosis.
  
  
  CONCLUSIONS
  Although treatment incidence for HCV has increased, there remain a large proportion of patients indicated for treatment who have yet to be treated.
authors.affiliation: University College London, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Grint
authors.forename: L
authors.initials: L
authors.lastname: Peters
authors.forename: C
authors.initials: C
authors.lastname: Schwarze-Zander
authors.forename: M
authors.initials: M
authors.lastname: Beniowski
authors.forename: C
authors.initials: C
authors.lastname: Pradier
authors.forename: M
authors.initials: M
authors.lastname: Battegay
authors.forename: D
authors.initials: D
authors.lastname: Jevtovic
authors.forename: V
authors.initials: V
authors.lastname: Soriano
authors.forename: J D
authors.initials: JD
authors.lastname: Lundgren
authors.forename: J K
authors.initials: JK
authors.lastname: Rockstroh
authors.forename: O
authors.initials: O
authors.lastname: Kirk
authors.forename: A
authors.initials: A
authors.lastname: Mocroft
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count / Q000706:statistics & numerical data; D015331:Cohort Studies; D060085:Coinfection; D004359:Drug Therapy, Combination; D005060:Europe / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D016012:Poisson Distribution; D011446:Prospective Studies; D012254:Ribavirin / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D012254:Ribavirin
keywords: EuroSIDA; HIV/HCV coinfection; PEG-interferon; ribavirin; treatment completion