title: Protease inhibitors to treat hepatitis C in the Swiss HIV Cohort Study: high efficacy but low treatment uptake.
abstract: OBJECTIVE
  Direct-acting antiviral agents (DAAs) have become the standard of care for the treatment of chronic hepatitis C virus (HCV) infection. We aimed to assess treatment uptake and efficacy in routine clinical settings among HIV/HCV coinfected patients after the introduction of the first generation DAAs.
  
  
  METHODS
  Data on all Swiss HIV Cohort Study (SHCS) participants starting HCV protease inhibitor (PI) treatment between September 2011 and August 2013 were collected prospectively. The uptake and efficacy of HCV therapy were compared with those in the time period before the availability of PIs.
  
  
  RESULTS
  Upon approval of PI treatment in Switzerland in September 2011, 516 SHCS participants had chronic HCV genotype 1 infection. Of these, 57 (11%) started HCV treatment during the following 2 years with either telaprevir, faldaprevir or boceprevir. Twenty-seven (47%) patients were treatment-naïve, nine (16%) were patients with relapse and 21 (37%) were partial or null responders. Twenty-nine (57%) had advanced fibrosis and 15 (29%) had cirrhosis. End-of-treatment virological response was 84% in treatment-naïve patients, 88% in patients with relapse and 62% in previous nonresponders. Sustained virological response was 78%, 86% and 40% in treatment-naïve patients, patients with relapse and nonresponders, respectively. Treatment uptake was similar before (3.8 per 100 patient-years) and after (6.1 per 100 patient-years) the introduction of PIs, while treatment efficacy increased considerably after the introduction of PIs.
  
  
  CONCLUSIONS
  The introduction of PI-based HCV treatment in HIV/HCV-coinfected patients improved virological response rates, while treatment uptake remained low. Therefore, the introduction of PIs into the clinical routine was beneficial at the individual level, but had only a modest effect on the burden of HCV infection at the population level.
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: V
authors.initials: V
authors.lastname: Schaerer
authors.affiliation: Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Haubitz
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: H
authors.initials: H
authors.lastname: Kovari
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: B
authors.initials: B
authors.lastname: Ledergerber
authors.affiliation: University Hospital Geneva, Geneva, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Ambrosioni
authors.affiliation: University Hospital Lausanne, Lausanne, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Cavassini
authors.affiliation: University Hospital Basel, Basel, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Stoeckle
authors.affiliation: Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Schmid
authors.affiliation: University Hospital Lausanne, Lausanne, Switzerland.
authors.forename: L
authors.initials: L
authors.lastname: Decosterd
authors.affiliation: University Hospital Lausanne, Lausanne, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Aouri
authors.affiliation: University of Zurich, Institute of Medical Virology, Zurich, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Böni
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: H F
authors.initials: HF
authors.lastname: Günthard
authors.affiliation: Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: H
authors.initials: H
authors.lastname: Furrer
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: K J
authors.initials: KJ
authors.lastname: Metzner
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Fehr
authors.affiliation: Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Rauch
mesh_terms: D000328:Adult; D000621:Aminoisobutyric Acids; D000998:Antiviral Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D007930:Leucine / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D009842:Oligopeptides / Q000627:therapeutic use; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011392:Proline / Q000031:analogs & derivatives / Q000627:therapeutic use; D011446:Prospective Studies; D011480:Protease Inhibitors / Q000627:therapeutic use*; D011804:Quinolines; D012367:RNA, Viral / Q000032:analysis; D013557:Switzerland; D013844:Thiazoles / Q000627:therapeutic use; D019562:Viral Load
chemical_list: D000621:Aminoisobutyric Acids; D000998:Antiviral Agents; D009842:Oligopeptides; D011480:Protease Inhibitors; D011804:Quinolines; D012367:RNA, Viral; D013844:Thiazoles; C486464:telaprevir; C512204:N-(3-amino-1-(cyclobutylmethyl)-2,3-dioxopropyl)-3-(2-((((1,1-dimethylethyl)amino)carbonyl)amino)-3,3-dimethyl-1-oxobutyl)-6,6-dimethyl-3-azabicyclo(3.1.0)hexan-2-carboxamide; C552340:faldaprevir; D011392:Proline; D007930:Leucine
keywords: hepatitis C virus protease inhibitors; hepatitis C virus/HIV coinfection; treatment efficacy; treatment uptake