Understanding unsuccessful direct-acting antiviral hepatitis C treatment among people living with HIV from the International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHECH)

Title

Understanding unsuccessful direct-acting antiviral hepatitis C treatment among people living with HIV from the International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHECH)

Presenter

Brendan Harney

Authors

B. Harney * (1,2,3), R. Sacks-Davis (1,2), D.K. van Santen (1,4), G. Matthews (5,6), M. Klein (7,8,9), K. Lacombe (10,11), L. Witkopp (12,13), M. van der Valk (14,15,16), M. Prins (4,14,15), I. Jarrin (17), A. Rauch (18), M. Hellard (1,2,3), J. Doyle (1,3), The International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC)

Institutions

(1) Burnet Institute, Disease Elimination Program, Melbourne, Australia, (2) Monash University, School of Public Health and Preventive Medicine, Melbourne, Australia, (3) Alfred Health and Monash University, Department of Infectious Diseases, Melbourne, Australia, (4) Public Health Service of Amsterdam, Department of Infectious Diseases, Research and Prevention, Amsterdam, Australia, (5) University of New South Wales, Kirby Institute, Sydney, Australia, (6) St Vincents Hospital, Sydney, Australia, (7) McGill University, Epidemiology, Biostatistics & Occupational Health, Montreal, Canada, (8) Canadian Institutes of Health Research, Canadian HIV Trials Network, Vancouver, Canada, (9) McGill University Health Centre, Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, Montreal, Canada, (10) Sorbonne Université, Institut Pierre Louis d''Ã?pidémiologie et de Santé Publique, Paris, France, (11) Hôpital Saint-Antoine, Service de Maladies Infectieuses, Paris, France, (12) CHU Bordeaux, Pôle de Santé Publique, Bordeaux, France, (13) University of Bordeaux, Department of Public Health, Bordeaux, France, (14) Amsterdam Universitair Medische Centra, University of Amsterdam, Department of Infectious Diseases, Amsterdam, Netherlands, the, (15) Amsterdam Universitair Medische Centra, University of Amsterdam, Amsterdam Infection & Immunity Institute, Amsterdam, Netherlands, the, (16) Stitching HIV Monitoring, Amsterdam, Netherlands, the, (17) Institute of Health Carlos III, Centro Nacional de Epidemiologia, Madrid, Spain, (18) Bern University Hospital, University of Bern, Department of Infectious Diseases, Inselspital, Bern, Switzerland

BACKGROUND: Historically, hepatitis C virus (HCV) was difficult to treat among people with HIV, however treatment with direct-acting antivirals (DAA) results in 90-95% of people being cured. There is a need to further understand why 5-10% are not successfully cured in order to ensure no one is left behind in HCV elimination efforts.
METHODS: Data were drawn from InCHECH and included data from Australia, Canada, France, the Netherlands, Spain, and Switzerland. People who had interferon-free DAA HCV treatment data recorded between 2014 & 2019 were included in analyses. Among people with at least one HCV RNA test 12 or more weeks after end of treatment (EOT), we used mixed-effects logistic regression to examine factors at treatment start associated with unsuccessful treatment, defined as a positive RNA test at their first test 12+ weeks after EOT. Factors included in univariable analyses were key population (gay and bisexual males, males with a history of injecting drug use, females with a history of injecting drug use, heterosexual or other exposure males and heterosexual or other exposure females), years since HIV diagnosis, HIV viral load, CD4 cell count, HCV genotype, cirrhosis, and previous interferon-based HCV treatment). Factors significant at 90% in univariable analyses, and age, were included in multivariable analyses.
RESULTS: Overall, 4554 people had DAA treatment data; the majority of whom were gay or bisexual males (46%) or had a history of injection drug use (37%). Of these people, 4509 (99%) had any HCV RNA data recorded, and 3844 (85%) had a test 12 or more weeks following EOT, ranging from 84% to 87% across key population groups. Unsuccessful treatment was 5.5% (212/3844) overall, ranging from 4% to 8% among key population groups. Adjusted for age and key population group, a CD4 cell count between 200-350 cells/mm³ was the only factor associated with unsuccessful treatment (aOR 1.78, 95%CI 1.20-2.63) compared to a CD4 cell count >350 cells/mm³.
CONCLUSIONS: We found that 5.5% of people with an SVR12+ test were unsuccessfully treated with minimal difference across key populations. Extra support through HCV treatment may be warranted among people with markers of sub-optimal HIV treatment.

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