title: Hepatitis C treatment initiation in HIV-HCV coinfected patients.
abstract: There are few data regarding HCV treatment initiation among HIV/HCV coinfected patients. The objective of this study was to analyze the changing patterns of HCV coinfection and HCV treatment initiation over time in a large French cohort of HIV/HCV coinfected patients at the beginning of DAA's era and to analyze factors associated with treatment initiation.
  
  
  
  All HIV/HCV coinfected patients enrolled during 2000-2012 were analyzed. HCV status was defined per calendar year as naïve, spontaneous cure, sustained virological response (SVR), failure or reinfection. HCV treatment initiation rate was determined per year. Trends over time were analyzed using Chi-2 test for trend and linear regression analysis. The effect of covariates on treatment initiation over time was analyzed using generalized estimating equations.
  
  
  
  Among 34,308 HIV-infected patients enrolled between 2000 and 2012, 5,562 were HCV coinfected. HCV prevalence declined from 38.4 to 15.1 %. HCV treatment initiation rate fluctuated from 5.6 to 7.4 %/year from 2000 to 2007, dropped to 5.6 % in 2011 and increased to 8.5 % in 2012 due to the use of first-generation DAAs (29.1 % of initiations in 2012). Cumulative HCV treatment initiation rate increased from 14.8 % in 2000 to 54.7 % in 2012. HCV cure rate increased from 12.4 to 45.2 %. Older age, male gender, male homosexuality, high CD4, undetectable HIV-RNA, CDC stage A-B, and severe fibrosis/cirrhosis were associated with a higher treatment initiation rate. The role of HCV genotype 1, CDC stage, fibrosis and recent HCV infection on treatment initiation rate changed over time.
  
  
  
  A high rate of HCV treatment initiation was observed at the beginning of DAAs era in HIV/HCV coinfected patients. Given the very high efficacy of new DAA-based regimens and if treatment initiation keeps increasing, HCV prevalence among HIV patients will drastically decrease during the forthcoming years.
authors.affiliation: Department of Infectious Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, INSERM U1052, Lyon, France. laurent.cotte@chu-lyon.fr.|Department of Infectious Diseases and Tropical Medicine, Croix-Rousse Hospital, 103 grande rue de la Croix-Rousse, 69317, Lyon, CEDEX 04, France. laurent.cotte@chu-lyon.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Cotte
authors.affiliation: Department of Infectious Diseases, Centre Hospitalier Universitaire de l'Archet, Nice, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Pugliese
authors.affiliation: Department of infectious diseases, Pitié-Salpêtrière Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.|UMR-S 943, INSERM, Paris, France.
authors.forename: Marc-Antoine
authors.initials: MA
authors.lastname: Valantin
authors.affiliation: INSERM, UMR 1027, Toulouse, F-31000, France.|Université de Toulouse III, Toulouse, F-31000, France.|CHU Toulouse, COREVIH Toulouse, F-31000, France.
authors.forename: Lise
authors.initials: L
authors.lastname: Cuzin
authors.affiliation: Department of Infectious Diseases, Hotel Dieu Hospital, Nantes, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Billaud
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, EA7327, Paris, France.|Assistance Publique - Hôpitaux de Paris - Hôpital Necker-Enfants malades, Service des Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur, IHU Imagine, Paris, France.
authors.forename: Claudine
authors.initials: C
authors.lastname: Duvivier
authors.affiliation: Department of Infectious Diseases, Centre Hospitalier Universitaire de l'Archet, Nice, France.
authors.forename: Alissa
authors.initials: A
authors.lastname: Naqvi
authors.affiliation: Department of infectious diseases, Centre Hospitalier de Tourcoing, Tourcoing, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Cheret
authors.affiliation: Department of Infectious Diseases, Hôpitaux Universitaires, Strasbourg, France.
authors.forename: David
authors.initials: D
authors.lastname: Rey
authors.affiliation: Center for Clinical Research, Department of Hepatology, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Pradat
authors.affiliation: Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille - Hôpital Sainte-Marguerite, Immuno-hematology clinic, 13009 Marseille France, Inserm U912 (SESSTIM), 13009, Marseille, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Poizot-Martin
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D060085:Coinfection / Q000188:drug therapy* / Q000453:epidemiology; D004359:Drug Therapy, Combination; D005260:Female; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D015497:HIV-1; D016174:Hepacivirus; D006526:Hepatitis C / Q000188:drug therapy* / Q000453:epidemiology; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000998:Antiviral Agents
keywords: Coinfection; Epidemiology; HCV; HIV; Treatment initiation