Rapid initiation of direct-acting antivirals and hepatitis C treatment outcomes in people with HIV: A real-world integrated care model.

OBJECTIVES

This study aimed to evaluate the impact of integrating HCV treatment with direct-acting antivirals (DAAs) into an HIV care setting at a medical center in Taiwan.

METHODS

We retrospectively reviewed the medical records of people with HIV (PWH) who received DAAs from 2019 to 2024. We examined the interval between detection HCV viremia and initiation of DAAs, treatment completion rate, and sustained virologic reponse at 12 wk post-treatment (SVR12).

RESULTS

During the study period, 345 PWH received 387 treatment courses of DAAs , and the median time from detection of HCV viremia to treatment initiation decreased from 421.5 days in 2019 to 31 days in 2022-2024 following the integration of HIV and HCV care. Treatment completion was 99.2%, and the overall -SVR12 rate was 95.1%. No significant differences in SVR12 rates were observed across the treatment years or between rapid (interval ≤30 days) versus standard initiation of DAAs. Among 368 individuals who achieved SVR12, 303 (82.3%) had at least one post-treatment HCV RNA test showing undetectable viremia. The median follow-up duration was 33.4 months (IQR, 16.6-53.4), with 45 reinfections identified-yielding an incidence rate of 4.87 per 100 person-years of follow-up (95% CI, 3.66-6.48). Reinfection occurred in both early and standard treatment groups, and most individuals with reinfections received DAA retreatment.

CONCLUSIONS

These findings highlight the feasibility and effectiveness of integrated HIV and HCV care in facilitating rapid DAA initiation in real-world setting. Scaling up this approach may help advance HCV elimination goals, especially among key populations with ongoing transmission risk.