Trends in HCV treatment uptake, efficacy and impact on liver fibrosis in the Swiss HIV Cohort Study

Background & Aims Hepatitis C virus ( HCV ) therapies with interferon‐free second‐generation direct‐acting antivirals ( DAA s) are highly effective and well tolerated. They have the potential to increase treatment eligibility and efficacy in HIV ‐infected patients. We assessed the impact of DAA s on treatment uptake and efficacy, as well as its impact on the burden of liver disease in the Swiss HIV Cohort Study ( SHCS ). Methods We describe clinical and virological characteristics of patients treated with second‐generation DAA s. We compared treatment incidence, sustained virological response ( SVR )12 and liver fibrosis stages between three time periods: period 1, 01/2009‐08/2011 (prior to the availability of DAA s); period 2, 09/2011‐03/2014 (first generation DAA s); period 3, 04/2014‐12/2015 (second generation DAA s). Results At the beginning of the third period, 876 SHCS participants had a chronic HCV infection of whom 180 (20%) started treatment with a second‐generation DAA . Three‐quarters of them had advanced liver fibrosis (Metavir ≥ F3) of whom 80% were cirrhotics. SVR 12 was achieved in 173/180 (96%) patients, three patients died and four experienced a virological failure. Over the three time periods, treatment uptake (4.5/100 py, 5.7/100 py, 22.4/100 py) and efficacy (54%, 70%, 96% SVR 12) continuously increased. The proportion of cirrhotic patients with replicating HCV infection in the SHCS declined from 25% at the beginning to 12% at the end of the last period. Conclusions After the introduction of second‐generation DAA s, we observed an increase in treatment uptake and efficacy which resulted in a significant reduction in the number of cirrhotic patients with a replicating HCV infection in the SHCS .