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

Clin Infect Dis. 2019 Oct 15;69(9):1613-1620. doi: 10.1093/cid/ciz008.


Background: 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.

Keywords: antiretroviral therapy; direct-acting antivirals; hepatitis C virus; human immunodeficiency virus; population intervention effects.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Antiviral Agents / therapeutic use*
  • Female
  • HIV / drug effects
  • HIV / pathogenicity
  • HIV Infections / drug therapy*
  • HIV Infections / mortality*
  • Hepatitis C, Chronic / drug therapy*
  • Humans
  • Male
  • Middle Aged


  • Antiviral Agents