Shanyinde, Milensu;
(2022)
Complication to managing HIV in relation to HCV in persons seen for routine clinical care in Italy.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Hepatitis C virus (HCV) is a global public health concern compared to communicable diseases such as HIV and shown to be associated with faster disease progression in PLWH. The introduction of highly effective direct acting antivirals (DAAs) in 2015 revolutionised HCV therapy. In 2015 WHO called for a global strategy in HCV elimination by 2030. Whilst DAA is recommended to all, HIV/HCV coinfected individuals may require special consideration. My initial research focused on the role of HCV as an effect modifier for the association between alcohol consumption and risk of severe liver disease (SLD) and the association between HCV and risk of specific ARV drug discontinuation in PLWH. This shifted to, real-world estimate of the presence of late HCV presentation and its risk of all-cause mortality. I evaluated regional differences in rate of accessing care with respect to HCV-RNA testing, DAA uptake and achieving sustained virological response (SVR). The data analysis involved two multicentre observational prospective cohorts enrolling PLWH with/without HCV in routine care across Italy. There was no evidence that HCV was an effect measure modifier for the relationship between alcohol consumption and risk of SLD. The rate of ARV discontinuation was similar between HIV/HCV coinfected and HIV monoinfected participants, except of darunavir/r for which the risk of discontinuation was higher in the coinfected. There was weak evidence for an association between late HCV presentation and risk of all-cause mortality. Among people enrolled between 2015 and 2018 in Icona, 90% were HCV-RNA tested and among those initiating DAA treatment, 88% achieved SVR. HIV/HCV coinfected individuals receiving care in the South had 50% (95%CI:34%–55%; p<0.001) reduced probability of initiating DAA compared to those receiving care in the North and Central regions. Overall, the results indicate that Italy is on course towards meeting the WHO HCV elimination goals in PLWH.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Complication to managing HIV in relation to HCV in persons seen for routine clinical care in Italy |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2022. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences |
| URI: | https://discovery-pp.ucl.ac.uk/id/eprint/10146190 |
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