@article{7d6b686a3aab46cdb36eb263f972964b,
title = "The Effects of Hepatitis C Treatment Eligibility Criteria on All-cause Mortality among People with Human Immunodeficiency Virus",
abstract = "The cost of direct-acting antivirals (DAAs) for hepatitis C virus (HCV) prompted many payers to restrict treatment to patients who met non-evidence-based criteria. These restrictions have implications for survival of people with HCV, especially for people with human immunodeficiency virus (HIV)/HCV coinfection who are at high risk for liver disease progression. The goal of this work was to estimate the effects of DAA access policies on 10-year all-cause mortality among people with HIV. Methods: The study population included 3056 adults with HIV in the Women's Interagency HIV Study and Multicenter AIDS Cohort Study from 1 October 1994 through 30 September 2015. We used the parametric g-formula to estimate 10-year all-cause mortality under DAA access policies that included treating (i) all people with HCV; (ii) only people with suppressed HIV; (iii) only people with severe fibrosis; and (iv) only people with HIV suppression and severe fibrosis. Results: The 10-year risk difference of treating all coinfected persons with DAAs compared with no treatment was -3.7% (95% confidence interval [CI], -9.1% to. 6%). Treating only those with suppressed HIV and severe fibrosis yielded a risk difference of -1.1% (95% CI, -2.8% to. 6%), with 51% (95% CI, 38%-59%) of coinfected persons receiving DAAs. Treating a random selection of 51% of coinfected persons at baseline decreased the risk by 1.9% (95% CI, -4.7% to. 3%). Conclusions: Restrictive DAA access policies may decrease survival compared to treating similar proportions of people with HIV/HCV coinfection with DAAs at random. These findings suggest that lives could be saved by thoughtfully revising access policies.",
keywords = "antiretroviral therapy, direct-acting antivirals, hepatitis C virus, human immunodeficiency virus, population intervention effects",
author = "Alexander Breskin and Daniel Westreich and Hurt, {Christopher B.} and Cole, {Stephen R.} and Hudgens, {Michael G.} and Seaberg, {Eric C.} and Thio, {Chloe L.} and Tien, {Phyllis C.} and Adimora, {Adaora A.}",
note = "Funding Information: Disclaimer. The contents of this publication are solely the responsibility of the authors and do not represent the official views of the NIH, Johns Hopkins ICTR, or NCATS. Financial support. This work was supported by NIAID (grant numbers R01 AI100654 to S. R. C., P30 AI50410 to M. G. H., U01 AI35042 to C. L. T., and K24 AI108516 to P. C. T.) and NICHD (grant number DP2 HD084070 to D. W. and A. B.). Funding Information: Acknowledgments. Data in this manuscript were collected by the Multicenter AIDS Cohort Study (MACS) and the Women{\textquoteright}s Interagency HIV Study (WIHS). MACS (Principal Investigators): Johns Hopkins University Bloomberg School of Public Health (Joseph Margolick, Todd Brown), U01 AI35042; Northwestern University (Steven Wolinsky), U01 AI35039; University of California, Los Angeles (Roger Detels, Otoniel Martinez-Maza, Otto Yang), U01 AI35040; University of Pittsburgh (Charles Rinaldo, Lawrence Kingsley, Jeremy Martinson), U01 AI35041; the Center for Analysis and Management of MACS, Johns Hopkins University Bloomberg School of Public Health (Lisa Jacobson, Gypsyamber D{\textquoteright}Souza), UM1 AI35043. The MACS is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), with additional co-funding from the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA), and the National Institute of Mental Health (NIMH). Targeted supplemental funding for specific projects was also provided by the National Heart, Lung, and Blood Institute and the National Institute on Deafness and Communication Disorders (NIDCD). MACS data collection is also supported by UL1 TR001079 (Johns Hopkins University Institute for Clinical and Translational Research [ICTR]) from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. WIHS (Principal Investigators): UAB-MS WIHS (Mirjam-Colette Kempf and Deborah Konkle-Parker), U01 AI103401; Atlanta WIHS (Ighovwerha Ofotokun and Gina Wingood), U01 AI103408; Bronx WIHS (Kathryn Anastos and Anjali Sharma), U01 AI035004; Brooklyn WIHS (Howard Minkoff and Deborah Gustafson), U01 AI031834; Chicago WIHS (Mardge Cohen and Audrey French), U01 AI034993; Metropolitan Washington WIHS (Seble Kassaye), U01 AI034994; Miami WIHS (Margaret Fischl and Lisa Metsch), U01 AI103397; University of North Carolina (UNC) WIHS (Adaora Adimora), U01 AI103390; Connie Wofsy Women{\textquoteright}s HIV Study, Northern California (Ruth Greenblatt, Bradley Aouizerat, and Phyllis Tien), U01 AI034989; WIHS Data Management and Analysis Center (Stephen Gange and Elizabeth Golub), U01 AI042590; Southern California WIHS (Joel Milam), U01 HD032632 (WIHS I–WIHS IV). The WIHS is funded primarily by NIAID, with additional co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NCI, NIDA, and NIMH. Targeted supplemental funding for specific projects is also provided by the National Institute of Dental and Craniofacial Research, the National Institute on Alcohol Abuse and Alcoholism, NIDCD, and the NIH Office of Research on Women{\textquoteright}s Health. WIHS data collection is also supported by UL1 TR000004 (UCSF Clinical and Translational Science Award [CTSA]), UL1 TR000454 (Atlanta CTSA), and P30 AI050410 (UNC Center for AIDS Research). The MACS website is located at http://aidscohortstudy.org/, and the WIHS website is located at http://wihshealth.org. Funding Information: Potential conflicts of interest. A. A. A. has received research funding from Gilead and personal fees from ViiV, and is on a Merck advisory board. C. B. H. supervised a clinical trial under an institutional contract between UNC and AbbVie. P. C. T. is conducting investigator-initiated research sponsored by Merck. C. L. T. has received research funding paid to her institution from Gilead Sciences and Sanofi. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. Publisher Copyright: {\textcopyright} 2019 The Author(s). Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.",
year = "2019",
month = oct,
day = "15",
doi = "10.1093/cid/ciz008",
language = "English (US)",
volume = "69",
pages = "1613--1620",
journal = "Clinical Infectious Diseases",
issn = "1058-4838",
publisher = "Oxford University Press",
number = "9",
}