HIV and Hepatitis C Treatment Uptake among People Who Use Drugs from the Amsterdam Cohort Studies, 1985-2013

Author: Van Santen D, Stolte I, van der Helm J, Lindenburg K, Schim van der Loeff M, Prins M

Theme: Clinical Research Year: 2015

Background: HIV-positive people who use drugs (PWUD) are more likely to start HIV treatment later and at lower CD4 cell counts compared with other HIV risk-groups. Moreover, although PWUD account for a large burden of HCV infection, HCV treatment uptake among PWUD remains low. In 2005, HCV treatment became easily accessible for PWUD at the Public Health Service of Amsterdam. We aim to assess the proportion (ever-) treated for HIV and HCV over time among PWUD from the Amsterdam Cohort Studies (ACS).
Methods: Data from 1985-2013 from the ACS were used. Ever treated was defined as ever receiving treatment for HIV and/or HCV. HIV treatment uptake, (i.e. any antiretroviral therapy), was calculated among all HIV-positive PWUD, irrespective of co-infection status. HCV treatment uptake was calculated among treatment naïve HCV-RNA positive PWUD, stratified by HCV/HIV-coinfection status. We calculated the proportion ever treated for HIV and HCV among PWUD who had a cohort visit during each calendar year. We also calculated the proportion on HCV treatment during a calendar year among PWUD with a cohort visit during that same year.
Results: Among 1,305 PWUD, we identified 362 HIV-antibody positive and 868 HCV-antibody positive PWUD. The proportion HIV-positive PWUD ever treated for HIV was 41.6% in 1996, 60.8% in 2000 and 92.9% in 2013. The proportion ever treated for HCV increased from 13.1% in 2005 to 46.9% in 2013 among HCV-monoinfected and from 0.0% to 17.8% among HCV/HIV-coinfected PWUD. During 2006, the highest proportion of PWUD on HCV treatment was observed (13.0%).
Conclusion: We observed an increase in the proportion ever treated for HIV and HCV among PWUD in the period of 1985-2013. The proportion on HCV treatment during 2006 was relatively high compared to other studies among PWUD outside the Netherlands. However, HCV/HIV-coinfected PWUD seem to be lagging behind in HCV treatment coverage.

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