title: Modelling the impact of deferring HCV treatment on liver-related complications in HIV coinfected men who have sex with men.
abstract: Hepatitis C (HCV) is a leading cause of morbidity and mortality in people who live with HIV. In many countries, access to direct acting antiviral agents to treat HCV is restricted to individuals with advanced liver disease (METAVIR stage F3 or F4). Our goal was to estimate the long term impact of deferring HCV treatment for men who have sex with men (MSM) who are coinfected with HIV and often have multiple risk factors for liver disease progression.
  
  
  
  We developed an individual-based model of liver disease progression in HIV/HCV coinfected MSM. We estimated liver-related morbidity and mortality as well as the median time spent with replicating HCV infection when individuals were treated in liver fibrosis stages F0, F1, F2, F3 or F4 on the METAVIR scale.
  
  
  
  The percentage of individuals who died of liver-related complications was 2% if treatment was initiated in F0 or F1. It increased to 3% if treatment was deferred until F2, 7% if it was deferred until F3 and 22% if deferred until F4. The median time individuals spent with replicating HCV increased from 5years if treatment was initiated in F2 to almost 15years if it was deferred until F4.
  
  
  
  Deferring HCV therapy until advanced liver fibrosis is established could increase liver-related morbidity and mortality in HIV/HCV coinfected individuals, and substantially prolong the time individuals spend with a replicating HCV infection.
authors.affiliation: Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
authors.forename: Cindy
authors.initials: C
authors.lastname: Zahnd
authors.affiliation: Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
authors.forename: Luisa
authors.initials: L
authors.lastname: Salazar-Vizcaya
authors.affiliation: Hepatology, University Clinic for Visceral Surgery and Medicine, University Hospital Bern, Bern, Switzerland.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dufour
authors.affiliation: Swiss Hepato-Pancreato-Biliary Center and Department of Gastroenterology and Hepatology, University Hospital Zürich, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Müllhaupt
authors.affiliation: Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; Department of Infectious Diseases, University of Dakar, Dakar, Senegal; Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Switzerland.
authors.forename: Gilles
authors.initials: G
authors.lastname: Wandeler
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and Institute of Medical Virology, University of Zurich, Switzerland.
authors.forename: Roger
authors.initials: R
authors.lastname: Kouyos
authors.affiliation: Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
authors.forename: Janne
authors.initials: J
authors.lastname: Estill
authors.affiliation: Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital, St-Gallen, Switzerland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bertisch
authors.affiliation: Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Switzerland. Electronic address: Andri.rauch@insel.ch.
authors.forename: Andri
authors.initials: A
authors.lastname: Rauch
authors.affiliation: Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
authors.forename: Olivia
authors.initials: O
authors.lastname: Keiser
mesh_terms: D000998:Antiviral Agents; D060085:Coinfection; D015658:HIV Infections; D006526:Hepatitis C; D006801:Humans; D008103:Liver Cirrhosis; D008297:Male; D000072339:Sexual and Gender Minorities
chemical_list: D000998:Antiviral Agents
keywords: Cirrhosis; HIV; Hepatitis C; Hepatocellular carcinoma; Mathematical model