High hepatic and extrahepatic mortality and low treatment uptake in HCV-coinfected persons in the Swiss HIV cohort study between 2001 and 2013.
OBJECTIVE
The landscape of HCV treatments is changing dramatically. At the beginning of this new era, we highlight the challenges for HCV therapy by assessing the long-term epidemiological trends in treatment uptake, efficacy and mortality among HIV/HCV-coinfected people since the availability of HCV therapy.


METHODS
We included all SHCS participants with detectable HCV RNA between 2001 and 2013. To identify predictors for treatment uptake uni- and multivariable Poisson regression models were applied. We further used survival analyses with Kaplan-Meier curves and Cox regression with drop-out as competing risk.


RESULTS
Of 12,401 participants 2107 (17%) were HCV RNA positive. Of those, 636 (30%) started treatment with an incidence of 5.8/100 person years (PY) (95% CI 5.3-6.2). Sustained virological response (SVR) with pegylated interferon/ribavirin was achieved in 50% of treated patients, representing 15% of all participants with replicating HCV-infection. 344 of 2107 (16%) HCV RNA positive persons died, 59% from extrahepatic causes. Mortality/100 PY was 2.9 (95% CI 2.6-3.2) in untreated patients, 1.3 (1.0-1.8) in those treated with failure, and 0.6 (0.4-1.0) in patients with SVR. In 2013, 869/2107 (41%) participants remained HCV RNA positive.


CONCLUSIONS
Over the last 13 years HCV treatment uptake was low and by the end of 2013, a large number of persons remain to be treated. Mortality was high, particularly in untreated patients, and mainly due to non-liver-related causes. Accordingly, in HIV/HCV-coinfected patients, integrative care including the diagnosis and therapy of somatic and psychiatric disorders is important to achieve mortality rates similar to HIV-monoinfected patients.
Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Zurich, University of Zurich, Switzerland. Electronic address: helen.kovari@usz.ch.
Helen
H
Kovari
Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Zurich, University of Zurich, Switzerland.
Bruno
B
Ledergerber
Division of Infectious Diseases, University Hospital, Lausanne, Switzerland.
Matthias
M
Cavassini
Division of Infectious Diseases, University Hospital, Geneva, Switzerland.
Juan
J
Ambrosioni
Division of Infectious Diseases, Cantonal Hospital, St. Gall, Switzerland.
Andrea
A
Bregenzer
Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Basle, Switzerland.
Marcel
M
Stöckle
Ospedale Regionale, Lugano, Switzerland.
Enos
E
Bernasconi
Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Zurich, University of Zurich, Switzerland; Institute of Medical Virology, University of Zurich, Switzerland.
Roger
R
Kouyos
Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Zurich, University of Zurich, Switzerland.
Rainer
R
Weber
University Clinic of Infectious Diseases, University Hospital Berne and University of Berne, Berne, Switzerland.
Andri
A
Rauch
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D060085:Coinfection / Q000401:mortality*; D005260:Female; D015658:HIV Infections / Q000401:mortality*; D006526:Hepatitis C / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012367:RNA, Viral / Q000032:analysis; D013997:Time Factors
D012367:RNA, Viral
Epidemiology; HCV; HIV; Mortality; Treatment