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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)

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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.