Direct-Acting Antiviral Initiation Among People With Hepatitis C Virus (HCV) and HIV on Antiretroviral Therapy in the United States and Canada: Factors Driving the HCV Treatment Gap - Report - MDSpire
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Direct-Acting Antiviral Initiation Among People With Hepatitis C Virus (HCV) and HIV on Antiretroviral Therapy in the United States and Canada: Factors Driving the HCV Treatment Gap
By
Raynell Lang
Elizabeth Humes
Asya Lyass
Leila H Borowsky
Brenna Hogan
Arthur Kim
Michael LaValley
Michael J Silverberg
H Nina Kim
Sonia Napravnik
Richard D Moore
Michael A Horberg
Frank J Palella
Greg D Kirk
Edward Cachay
George A Yendewa
Seble Kassaye
Kathleen McGinnis
Sally B Coburn
Timothy R Sterling
Marina B Klein
Mari M Kitahata
Catherine Lesko
Virginia A Triant
Keri N Althoff
on behalf the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of the International Epidemiologic Databases to Evaluate AIDS (IeDEA)
Factors Influencing DAA Initiation for Hepatitis C in HIV-Positive Adults in US and Canada
Overview
Among 6300 HIV-positive individuals with detectable HCV RNA, 58% initiated direct-acting antiviral (DAA) therapy by 2021. Disparities in DAA initiation were observed by race/ethnicity, substance use, and HIV disease markers despite overall narrowing of the treatment gap over time.
Background
People with HIV (PWH) are at increased risk for hepatitis C virus (HCV) coinfection and experience worse liver-related outcomes than those with HCV alone. The advent of DAAs has revolutionized HCV treatment with cure rates exceeding 95%, and PWH are prioritized for HCV elimination efforts due to frequent healthcare engagement. However, barriers such as substance use, mental illness, and socioeconomic factors may impede equitable access to DAAs among PWH. Understanding factors influencing DAA initiation is critical to closing the treatment gap and achieving WHO elimination targets.
Data Highlights
Characteristic
DAA Initiation Rate
Total PWH with detectable HCV RNA
6300
Initiated DAA
3672 (58%)
Not initiated DAA by 8 years
6%
Lower initiation among non-Hispanic Black and Hispanic PWH
Yes
Lower initiation with injection drug use, at-risk alcohol use, smoking
Yes
Lower initiation with detectable HIV viremia or history of AIDS
Yes
Higher initiation with increased Fibrosis-4 score
Yes
Key Findings
58% of HIV-positive individuals with detectable HCV RNA initiated DAA therapy during the study period.
Non-Hispanic Black and Hispanic PWH had significantly lower rates of DAA initiation compared to non-Hispanic White PWH.
Injection drug use as HIV acquisition risk, at-risk alcohol use, and smoking were associated with reduced likelihood of starting DAA treatment.
Detectable HIV viral load and history of AIDS correlated with lower DAA initiation rates.
Higher liver fibrosis scores (Fibrosis-4) were linked to increased DAA initiation, indicating prioritization of advanced liver disease.
The overall DAA treatment gap among PWH engaged in care has narrowed over time but disparities persist.
Clinical Implications
Clinicians should be aware of persistent disparities in DAA initiation among racial/ethnic minorities and individuals with substance use or uncontrolled HIV. Targeted interventions addressing these barriers are essential to ensure equitable access to curative HCV therapy. Monitoring liver fibrosis may help prioritize treatment but should not delay therapy in eligible patients.
Conclusion
While DAA initiation among PWH with HCV has improved substantially, disparities remain that require focused strategies to achieve HCV elimination goals in this vulnerable population.
References
North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) -- Factors Influencing DAA Initiation in HIV/HCV Coinfection
World Health Organization 2016 -- Global Health Sector Strategy on Viral Hepatitis
by Raynell Lang, Elizabeth Humes, Asya Lyass, Leila H Borowsky, Brenna Hogan, Arthur Kim, Michael LaValley, Michael J Silverberg, H Nina Kim, Sonia Napravnik, Richard D Moore, Michael A Horberg, Frank J Palella, Greg D Kirk, Edward Cachay, George A Yendewa, Seble Kassaye, Kathleen McGinnis, Sally B Coburn, Timothy R Sterling, Marina B Klein, Mari M Kitahata, Catherine Lesko, Virginia A Triant, Keri N Althoff, on behalf the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of the International Epidemiologic Databases to Evaluate AIDS (IeDEA)
