Restrictive direct-acting antivirals (DAA) access policies may decrease survival compared to treating similar proportions of people with HIV/HCV coinfection with DAAs at random, a new study suggests. The study population include 3,056 adults with HIV in the Women’s Interagency HIV Study and Multicenter AIDS Cohort Study from October 1, 1994, through September 30, 2015. Researchers estimated 10-year all-cause mortality under DAA access policies that included testing: 1) all people with HCV; 2) only people with suppressed HIV; 3) only people with severe fibrosis; and 4) only people with HIV suppression and severe fibrosis. They found:
- The 10-year risk difference of treating all coinfected persons with DAAs compared with no treatment was ‒3.7%.
- Treating only those with suppressed HIV and severe fibrosis resulted in a risk difference of ‒1.1%, with 51% of coinfected persons receiving DAAs.
- Treating a random selection of 51% of coinfected persons at baseline decreased the risk by 1.9%.
Breskin A, Westreich D, Hurt CB, et al. The effects of hepatitis C treatment eligibility criteria on all-cause mortality among people with HIV. [Published online ahead of print January 7, 2019]. Clin Infect Dis. doi:10.1093/cid/ciz008.