title: Impact of universal access to hepatitis C therapy on HIV-infected patients: implementation of the Spanish national hepatitis C strategy.
abstract: In April 2015, the Spanish National Health System (SNHS) developed a national strategic plan for the diagnosis, treatment, and management of hepatitis C virus (HCV). Our aim was to analyze the impact of this on human immunodeficiency virus (HIV)-infected patients included in the HERACLES cohort during the first 6 months of its implementation. The HERACLES cohort (NCT02511496) was set up in March 2015 to evaluate the status and follow-up of chronic HCV infection in patients co-infected with HIV in the south of Spain. In September 2015, the data were analyzed to identify clinical events (death, liver decompensation, and liver fibrosis progression) and rate of treatment implementation in this population. The study population comprised a total of 3474 HIV/HCV co-infected patients. The distribution according to liver fibrosis stage was: 1152 F0-F1 (33.2 %); 513 F2 (14.4 %); 641 F3 (18.2 %); 761 F4 (21.9 %); and 407 whose liver fibrosis was not measured (12.3 %). During follow-up, 248 patients progressed by at least one fibrosis stage [7.1 %; 95 % confidence interval (CI): 6.3-8 %]. Among cirrhotic patients, 52 (6.8 %; 95 % CI: 5.2-8.9 %) developed hepatic decompensation. In the overall population, 50 patients died (1.4 %; 95 % CI: 1.1-1.9 %). Eight hundred and nineteen patients (23.56 %) initiated interferon (IFN)-free treatment during follow-up, of which 47.8 % were cirrhotic. In our study, during 6 months of follow-up, 23.56 % of HIV/HCV co-infected patients included in our cohort received HCV treatment. However, we observed a high incidence of negative short-term outcomes in our population.
authors: Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain. arjvet@gmail.com.
authors: A
authors: A
authors: Rivero-Juarez
authors: Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain.
authors: L F
authors: LF
authors: Lopez-Cortes
authors: Unidad Clínica de Enfermedades Infecciosas, Hospital Regional Universitario Carlos Haya, Málaga, Spain.
authors: M
authors: M
authors: Castaño
authors: Unidad Clínica de Enfermedades Infecciosas, Complejo Hospitalario Universitario de Huelva, Huelva, Spain.
authors: D
authors: D
authors: Merino
authors: Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Regional Universitario Virgen de la Victoria, Málaga, Spain.
authors: M
authors: M
authors: Marquez
authors: Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario de Valme, Seville, Spain.
authors: M
authors: M
authors: Mancebo
authors: Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain.
authors: F
authors: F
authors: Cuenca-Lopez
authors: Unidad Clínica de Enfermedades Infecciosas, Hospital Universitario Puerto Real, Cádiz, Spain.
authors: P
authors: P
authors: Jimenez-Aguilar
authors: Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain.
authors: I
authors: I
authors: Lopez-Montesinos
authors: Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital de Jerez, Jerez, Spain.
authors: S
authors: S
authors: Lopez-Cardenas
authors: Unidad Clínica de Enfermedades Infecciosas, Complejo Hospitalario Torrecárdenas, Almería, Spain.
authors: A
authors: A
authors: Collado
authors: Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de las Nieves, Granada, Spain.
authors: M A
authors: MA
authors: Lopez-Ruz
authors: Unidad Clínica de Enfermedades Infecciosas, Complejo Hospitalario de Jaén, Jaén, Spain.
authors: M
authors: M
authors: Omar
authors: Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital La Línea, AGS Campo de Gibraltad, Cádiz, Spain.
authors: F
authors: F
authors: Tellez
authors: Unidad de Medicina Interna, Hospital Costa del Sol, Marbella, Spain.
authors: X
authors: X
authors: Perez-Stachowski
authors: Unidad Clínica de Enfermedades Infecciosas, Hospital Universitario San Cecilio, Granada, Spain.
authors: J
authors: J
authors: Hernandez-Quero
authors: Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Puerta del Mar, Cádiz, Spain.
authors: J A
authors: JA
authors: Girón-Gonzalez
authors: Unidad de Medicina Tropical, Hospital de Poniente, El Ejido, Spain.
authors: E
authors: E
authors: Fernandez-Fuertes
authors: Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía de Córdoba, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain. ariveror@gmail.com.
authors: A
authors: A
authors: Rivero
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006291:Health Policy; D006297:Health Services Accessibility; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology* / Q000473:pathology; D017093:Liver Failure / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013030:Spain; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents