Abstract
In April 2015, the Spanish National Health System (SNHS) developed a national strategic plan for the diagnosis, treatment, and management of hepatitis C virus (HCV). Our aim was to analyze the impact of this on human immunodeficiency virus (HIV)-infected patients included in the HERACLES cohort during the first 6 months of its implementation. The HERACLES cohort (NCT02511496) was set up in March 2015 to evaluate the status and follow-up of chronic HCV infection in patients co-infected with HIV in the south of Spain. In September 2015, the data were analyzed to identify clinical events (death, liver decompensation, and liver fibrosis progression) and rate of treatment implementation in this population. The study population comprised a total of 3474 HIV/HCV co-infected patients. The distribution according to liver fibrosis stage was: 1152 F0–F1 (33.2 %); 513 F2 (14.4 %); 641 F3 (18.2 %); 761 F4 (21.9 %); and 407 whose liver fibrosis was not measured (12.3 %). During follow-up, 248 patients progressed by at least one fibrosis stage [7.1 %; 95 % confidence interval (CI): 6.3–8 %]. Among cirrhotic patients, 52 (6.8 %; 95 % CI: 5.2–8.9 %) developed hepatic decompensation. In the overall population, 50 patients died (1.4 %; 95 % CI: 1.1–1.9 %). Eight hundred and nineteen patients (23.56 %) initiated interferon (IFN)-free treatment during follow-up, of which 47.8 % were cirrhotic. In our study, during 6 months of follow-up, 23.56 % of HIV/HCV co-infected patients included in our cohort received HCV treatment. However, we observed a high incidence of negative short-term outcomes in our population.
Highlights
The high efficacy and safety of direct-acting antiviral drugs (DAAs) used for the treatment of hepatitis C virus (HCV) has meant a significant improvement in cure rates [defined as sustained virological response (SVR)] and, as a direct result, an improved prognosis for this infectious disease [1,2,3]
A total of 3474 human immunodeficiency virus (HIV)/HCV co-infected patients were included in the cohort and formed the study population
We report the first results of the impact of the Spanish national strategic plan for the diagnosis, treatment, and management of HCV on HIV/HCV co-infected patients in the HERACLES cohort
Summary
The high efficacy and safety of direct-acting antiviral drugs (DAAs) used for the treatment of hepatitis C virus (HCV) has meant a significant improvement in cure rates [defined as sustained virological response (SVR)] and, as a direct result, an improved prognosis for this infectious disease [1,2,3]. Incorporating DAAs into patient care requires implementing new and expensive resources, so limiting their application in countries like Spain, which have universal free healthcare systems In this regard, in April 2015, the Spanish National Health System (SNHS) developed a strategic plan for diagnosing, treating, and managing HCV throughout Spain [4]. This plan was approved in April 2015 and extended across four strategic action lines, each with different objectives and key action points These lines included: (i) quantifying the magnitude of this disease; (ii) defining the clinical criteria for implementing appropriate treatment; (iii) establishing coordination mechanisms to guarantee the proper implementation of the plan; and (iv) promoting knowledge about the prevention, diagnosis, and treatment of HCV by fomenting clinical and basic research [4]. The development and implementation of this plan, constitutes a major advance in the eradication of HCV in Spain
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