Evolution of patients' socio-behavioral characteristics in the context of DAA: Results from the French ANRS CO13 HEPAVIH cohort of HIV-HCV co-infected patients

PLoS One. 2018 Jul 5;13(7):e0199874. doi: 10.1371/journal.pone.0199874. eCollection 2018.

Abstract

Background: Direct-acting antivirals (DAA) have dramatically increased HCV cure rates with minimal toxicity in HIV-HCV co-infected patients. This study aimed to compare the socio-behavioral characteristics of patients initiating pegylated-interferon (PEG-IFN)-based HCV treatment with those of patients initiating DAA-based treatment.

Methods: ANRS CO13 HEPAVIH is a national multicenter prospective cohort started in 2005, which enrolled 1,859 HIV-HCV co-infected patients followed up in French hospital outpatient units. Both clinical/biological and socio-behavioral data were collected during follow-up. We selected patients with socio-behavioral data available before HCV treatment initiation.

Results: A total of 580 patients were included in this analysis. Of these, 347 initiated PEG-IFN-based treatment, and 233 DAA-based treatment. There were significant differences regarding patient mean age (45 years±6 for the PEG-IFN group vs. 52 years±8 for the DAA group, p<0.001), unstable housing (21.4% vs. 11.2%, p = 0.0016), drug use (44.7% vs. 29.6%, p = 0.0003), regular or daily use of cannabis (24.3% vs. 15.6%, p = 0.0002), a history of drug injection (68.9% vs 39.0%, p<0.0001) and significant liver fibrosis (62.4% vs 72.3%, p = 0.0293). In multivariable analysis, patients initiating DAA-based treatment were older than their PEG-IFN-based treatment counterparts (aOR = 1.17; 95%CI [1.13; 1.22]). Patients receiving DAA treatment were less likely to report unstable housing (0.46 [0.24; 0.88]), cannabis use (regular or daily use:0.50 [0.28; 0.91]; non-regular use: 0.41 [0.22; 0.77]), and a history of drug injection (0.19 [0.12; 0.31]).

Conclusion: It is possible that a majority of patients who had socio-economic problems and/or a history of drug injection and/or a non-advanced disease stage were already treated for HCV in the PEG-IFN era. Today, patients with unstable housing conditions are prescribed DAA less frequently than other populations. As HCV treatment is prevention, improving access to DAA remains a major clinical and public health strategy, in particular for individuals with high-risk behaviors.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antiviral Agents / therapeutic use*
  • Clinical Trials as Topic
  • Coinfection / drug therapy
  • Coinfection / psychology*
  • Coinfection / virology
  • Female
  • HIV / isolation & purification
  • HIV Infections / drug therapy
  • HIV Infections / psychology*
  • HIV Infections / virology
  • Health Behavior*
  • Hepacivirus / isolation & purification
  • Hepatitis C / drug therapy
  • Hepatitis C / psychology*
  • Hepatitis C / virology
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Substance-Related Disorders / epidemiology*
  • Substance-Related Disorders / psychology
  • Young Adult

Substances

  • Antiviral Agents

Grants and funding

This work was supported by the French National Agency for Research on AIDS and Viral Hepatitis (ANRS), with the participation of Abbott France; Glaxo-Smith- Kline; Roche; Schering-Plough; and INSERM’s ‘Programme Cohortes TGIR’. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. There was no additional external funding received for this study.