All-cause mortality before and after DAA availability among people living with HIV and HCV: An international comparison between 2010 and 2019 - Archive ouverte HAL
Article Dans Une Revue International Journal of Drug Policy Année : 2024

All-cause mortality before and after DAA availability among people living with HIV and HCV: An international comparison between 2010 and 2019

Maria-Bernarda Requena
  • Fonction : Auteur
Camelia Protopopescu
  • Fonction : Auteur
Ashleigh C Stewart
  • Fonction : Auteur
Daniela K van Santen
  • Fonction : Auteur
Marina B Klein
  • Fonction : Auteur
Inmaculada Jarrin
  • Fonction : Auteur
Juan Berenguer
  • Fonction : Auteur
Dominique Salmon
Andri Rauch
  • Fonction : Auteur
Maria Prins
  • Fonction : Auteur
Marc van der Valk
  • Fonction : Auteur
Rachel Sacks-Davis
  • Fonction : Auteur
Margaret E Hellard
  • Fonction : Auteur
Patrizia Carrieri
  • Fonction : Auteur
Karine Lacombe
  • Fonction : Auteur

Résumé

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/mm(3) (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.
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Dates et versions

hal-04467710 , version 1 (20-02-2024)

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Citer

Maria-Bernarda Requena, Camelia Protopopescu, Ashleigh C Stewart, Daniela K van Santen, Marina B Klein, et al.. All-cause mortality before and after DAA availability among people living with HIV and HCV: An international comparison between 2010 and 2019. International Journal of Drug Policy, 2024, 124, pp.104311. ⟨10.1016/j.drugpo.2023.104311⟩. ⟨hal-04467710⟩

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