All-cause mortality before and after DAA availability among people living with HIV and HCV : An international comparison between 2010 and 2019
Copyright © 2023 Elsevier B.V. All rights reserved..
BACKGROUND: Among people living with HIV and hepatitis C virus (HCV), people who inject drugs (PWID) have historically experienced higher mortality rates. Direct-acting antivirals (DAA), which have led to a 90 % HCV cure rate independently of HIV co-infection, have improved mortality rates. However, DAA era mortality trends among PWID with HIV/HCV remain unknown. Using data from the International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC), we compared pre/post-DAA availability mortality changes in three groups: PWID, men who have sex with men (MSM), and all other participants.
METHODS: We included InCHEHC participants with HIV/HCV followed between 2010 and 2019 in Canada, France, the Netherlands, Spain, and Switzerland. All-cause mortality hazard was compared in the three groups, using Cox proportional hazards regression models adjusted for sex, age, advanced fibrosis/cirrhosis, and pre/post DAA availability.
RESULTS: Of the 11,029 participants, 76 % were men, 46 % were PWID, baseline median age was 46 years (interquartile range [IQR] = 40;51), and median CD4 T-cell count was 490 cells/mm3 (IQR = 327;689). Over the study period (median follow-up = 7.2 years (IQR = 3.7;10.0)), 6143 (56 %) participants received HCV treatment, 4880 (44 %) were cured, and 1322 participants died (mortality rate = 1.81/100 person-years (PY) [95 % confidence interval (CI)=1.72-1.91]). Overall, PWID had higher mortality rates than MSM (2.5/100 PY [95 % CI = 2.3-2.6] vs. 0.8/100 PY [95 % CI = 0.7-0.9], respectively). Unlike women with other transmission modes, those who injected drugs had a higher mortality hazard than men who did not inject drugs and men who were not MSM (adjusted Hazard-Ratio (aHR) [95 % CI] = 1.3[1.0-1.6]). Post-DAA availability, mortality decreased among MSM in the Netherlands, Spain, and Switzerland and increased among PWID in Canada (aHR [95 % CI] = 1.73 [1.15-2.61]).
CONCLUSION: Post-DAA availability, all-cause mortality did not decrease in PWID. Determinants of cause-specific deaths (drug-related, HIV-related, or HCV-related) need to be identified to explain persistently high mortality among PWID in the DAA era.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:124 |
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| Enthalten in: |
The International journal on drug policy - 124(2024) vom: 05. Feb., Seite 104311 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Requena, Maria-Bernarda [VerfasserIn] |
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| Links: |
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| Themen: |
Antiviral Agents |
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| Anmerkungen: |
Date Completed 11.03.2024 Date Revised 11.03.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.drugpo.2023.104311 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM366755196 |
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| 100 | 1 | |a Requena, Maria-Bernarda |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a All-cause mortality before and after DAA availability among people living with HIV and HCV |b An international comparison between 2010 and 2019 |
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| 500 | |a Date Completed 11.03.2024 | ||
| 500 | |a Date Revised 11.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 Elsevier B.V. All rights reserved. | ||
| 520 | |a BACKGROUND: Among people living with HIV and hepatitis C virus (HCV), people who inject drugs (PWID) have historically experienced higher mortality rates. Direct-acting antivirals (DAA), which have led to a 90 % HCV cure rate independently of HIV co-infection, have improved mortality rates. However, DAA era mortality trends among PWID with HIV/HCV remain unknown. Using data from the International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC), we compared pre/post-DAA availability mortality changes in three groups: PWID, men who have sex with men (MSM), and all other participants | ||
| 520 | |a METHODS: We included InCHEHC participants with HIV/HCV followed between 2010 and 2019 in Canada, France, the Netherlands, Spain, and Switzerland. All-cause mortality hazard was compared in the three groups, using Cox proportional hazards regression models adjusted for sex, age, advanced fibrosis/cirrhosis, and pre/post DAA availability | ||
| 520 | |a RESULTS: Of the 11,029 participants, 76 % were men, 46 % were PWID, baseline median age was 46 years (interquartile range [IQR] = 40;51), and median CD4 T-cell count was 490 cells/mm3 (IQR = 327;689). Over the study period (median follow-up = 7.2 years (IQR = 3.7;10.0)), 6143 (56 %) participants received HCV treatment, 4880 (44 %) were cured, and 1322 participants died (mortality rate = 1.81/100 person-years (PY) [95 % confidence interval (CI)=1.72-1.91]). Overall, PWID had higher mortality rates than MSM (2.5/100 PY [95 % CI = 2.3-2.6] vs. 0.8/100 PY [95 % CI = 0.7-0.9], respectively). Unlike women with other transmission modes, those who injected drugs had a higher mortality hazard than men who did not inject drugs and men who were not MSM (adjusted Hazard-Ratio (aHR) [95 % CI] = 1.3[1.0-1.6]). Post-DAA availability, mortality decreased among MSM in the Netherlands, Spain, and Switzerland and increased among PWID in Canada (aHR [95 % CI] = 1.73 [1.15-2.61]) | ||
| 520 | |a CONCLUSION: Post-DAA availability, all-cause mortality did not decrease in PWID. Determinants of cause-specific deaths (drug-related, HIV-related, or HCV-related) need to be identified to explain persistently high mortality among PWID in the DAA era | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Direct-acting antivirals | |
| 650 | 4 | |a HIV | |
| 650 | 4 | |a Hepatitis C virus | |
| 650 | 4 | |a Mortality | |
| 650 | 4 | |a People who inject drugs | |
| 650 | 7 | |a Antiviral Agents |2 NLM | |
| 700 | 1 | |a Protopopescu, Camelia |e verfasserin |4 aut | |
| 700 | 1 | |a Stewart, Ashleigh C |e verfasserin |4 aut | |
| 700 | 1 | |a van Santen, Daniela K |e verfasserin |4 aut | |
| 700 | 1 | |a Klein, Marina B |e verfasserin |4 aut | |
| 700 | 1 | |a Jarrin, Inmaculada |e verfasserin |4 aut | |
| 700 | 1 | |a Berenguer, Juan |e verfasserin |4 aut | |
| 700 | 1 | |a Wittkop, Linda |e verfasserin |4 aut | |
| 700 | 1 | |a Salmon, Dominique |e verfasserin |4 aut | |
| 700 | 1 | |a Rauch, Andri |e verfasserin |4 aut | |
| 700 | 1 | |a Prins, Maria |e verfasserin |4 aut | |
| 700 | 1 | |a van der Valk, Marc |e verfasserin |4 aut | |
| 700 | 1 | |a Sacks-Davis, Rachel |e verfasserin |4 aut | |
| 700 | 1 | |a Hellard, Margaret E |e verfasserin |4 aut | |
| 700 | 1 | |a Carrieri, Patrizia |e verfasserin |4 aut | |
| 700 | 1 | |a Lacombe, Karine |e verfasserin |4 aut | |
| 700 | 0 | |a InCHEHC Collaboration |e verfasserin |4 aut | |
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