The Effects of Hepatitis C Treatment Eligibility Criteria on All-cause Mortality among People with Human Immunodeficiency Virus

Alexander Breskin, Daniel Westreich, Christopher B. Hurt, Stephen R. Cole, Michael G. Hudgens, Eric C. Seaberg, Chloe L. Thio, Phyllis C. Tien, Adaora A. Adimora

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1613-1620
Number of pages8
JournalClinical Infectious Diseases
Issue number9
StatePublished - Oct 15 2019


  • antiretroviral therapy
  • direct-acting antivirals
  • hepatitis C virus
  • human immunodeficiency virus
  • population intervention effects

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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