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Unrestricted Dutch Athena Cohort (HIV+/MSM/IDU) DAA Access Leads to Speedy Uptake, High Cure Rates ....'51% decrease in acute HCV, increased STD rates/syphillis'
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Conference on Retroviruses and Opportunistic Infections (CROI), February 13-16, 2017, Seattle
WEBCAST: http://www.croiwebcasts.org/console/player/33566?mediaType=slideVideo&
Mark Mascolini
Unrestricted reimbursement for anti-HCV direct-acting antivirals (DAAs) in the Netherlands led to rapid uptake of the potent drugs by HCV/HIV-coinfected people and to high cure rates [1]. Three quarters of DAA-treated HCV/HIV-coinfected men who have sex with men (MSM) are cured or likely to be cured, a Dutch team estimates.
From September 2014 through November 2015, the Netherlands reimbursed treatment of advanced HCV infection (METAVIR F3 or F4) with all oral DAAs. At that point the country decided to reimburse DAA therapy for all chronic HCV infection, regardless of METAVIR score (F0 through F4). The Dutch Ministry of Health recognizes 26 HIV treatment centers across the country. The Dutch ATHENA cohort collects demographic and clinical data on 98% of HIV patients at these centers. Among people with HIV, 22,042 have been screened for HCV at least once.
This analysis of DAA therapy in ATHENA came in two stages--a cohort analysis in May 2016 (a half-year after the Netherlands authorized unrestricted DAA access) and a data update in January 2017. Among 22,042 cohort members screened for HCV, 2422 (11%) had a positive HCV RNA test. After subtracting those who died, had spontaneous HCV clearance, or left the cohort for other reasons, the researchers had 1420 HCV/HIV patients in care in May 2016. Most (89%) were men, 68% were Dutch, 68% were MSM, and age averaged 49 years. One third had severe liver disease.
Among the 1420 HCV/HIV patients in care in May 2016, 1120 (79%) began treatment, 1026 (72%) completed treatment, and 829 (58%) achieved sustained virologic response (SVR). At the time of this analysis, treatment was ongoing in another 94 patients. If they are added to the 829 who already achieved SVR, the anticipated SVR rate will be 65%. Almost half of the people who began and completed treatment used contemporary DAAs, while the others took pegylated interferon plus boceprevir or telaprevir. Among the 829 cured, 404 (49%) took DAAs and 425 took boceprevir or telaprevir plus interferon.
In the January 2017 update, 939 of 1420 people have achieved SVR (55% treated with DAAs). If 49 people with ongoing treatment achieve SVR, the total SVR rate will climb to 70% (988 of 1420). The researchers estimate that 69% of people with severe liver disease have achieved SVR or are currently taking DAAs. Estimated SVR/on-treatment proportions are 76% for MSM and 54% for non-MSM.
"65% cured or expiated to be cured in the very near future”
Certain groups in the Netherlands still need DAA therapy, the investigators report. Among HCV/HIV-infected people not yet taking DAAs in January 2017, 37% are former drug injectors. Yet among people already cured or in treatment, only 11% are former drug injectors. Respective proportions not yet on DAAs/already cured or on treatment are 22% versus 9% for females, 6% versus 2% for people with a current sub-200 CD4 count, 13% versus 4% for people with a 100-copy or higher HIV load, and 11% versus 3% for people not taking antiretroviral therapy.
Another analysis by Dutch researchers, reported separately by NATAP, figured that incidence of acute HCV infection fell by half among HIV-positive MSM in the Netherlands after the DAA rollout [2].
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SUBSTANTIAL DECLINE IN ACUTE HCV INFECTIONS AMONG DUTCH HIV+MSM AFTER DAA ROLL OUT....51% decline in acute HCV after unrestricted DAA access, increased STD rates/syphillis
Bart Rijnders
Erasmus MC Rotterdam, Rotterdam, Netherlands
WEBCAST: http://www.croiwebcasts.org/console/player/33567?mediaType=slideVideo&
References
1. Boerekamps A, Newsum A, Smit C, et al. Unrestricted DAA access in the Netherlands: rapid therapy uptake in HIV+HCV+ patients. Conference on Retroviruses and Opportunistic Infections (CROI), February 13-16, 2017, Seattle. Abstract 136.
2. Boerekamps A, van den Berk G, Lauw F, et al. Substantial decline in acute HCV infections among Dutch HIV+MSM after DAA roll out. Conference on Retroviruses and Opportunistic Infections (CROI), February 13-16, 2017, Seattle. Abstract 137LB.
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