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Optimal timing of hepatitis C treatment among HIV/HCV coinfected ESRD patients: Pre‐ vs posttransplant
Author(s) -
Shelton Brittany A.,
Berdahl Gideon,
Sawinski Deirdre,
Linas Benjamin P.,
Reese Peter P.,
Mustian Margaux N.,
Reed Rhian D.,
MacLennan Paul A.,
Locke Jayme E.
Publication year - 2019
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15239
Subject(s) - medicine , hepatitis c , dialysis , liver disease , hepatitis c virus , cirrhosis , transient elastography , liver transplantation , kidney disease , transplantation , liver fibrosis , immunology , virus
Patients with end‐stage renal disease (ESRD) who are coinfected with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) have access to effective treatment options for HCV infection. However, they also have access to HCV‐infected kidneys, which historically afford shorter times to transplantation. Given the high waitlist mortality and rapid progression of liver fibrosis among coinfected kidney‐only transplant candidates, identification of the optimal treatment strategy is paramount. Two strategies, treatment pre‐ and posttransplant, were compared using Monte Carlo microsimulation of 1 000 000 candidates. The microsimulation was stratified by liver fibrosis stage at waitlist addition and wait‐time over a lifetime time horizon. Treatment posttransplant was consistently cost‐saving as compared to treatment pretransplant due to the high cost of dialysis. Among patients with low fibrosis disease (F0‐F1), treatment posttransplant also yielded higher life months (LM) and quality‐adjusted life months (QALM), except among F1 candidates with wait times ≥ 18 months. For candidates with advanced liver disease (F2‐F4), treatment pretransplant afforded more LM and QALM unless wait time was <18 months. Moreover, treatment pretransplant was cost‐effective for F2 candidates with wait times >71 months and F3 candidates with wait times >18 months. Thus, optimal timing of HCV treatment differs based on liver disease severity and wait time, favoring pretransplant treatment when cirrhosis development prior to transplant seems likely.