ABSTRACT
OBJECTIVES: Direct-acting antiviral agents (DAAs) have become the standard of care for the treatment of chronic hepatitis C virus (HCV) infection. We aimed to assess treatment uptake and efficacy in routine clinical settings among HIV/HCV coinfected patients after the introduction of the first generation DAAs. METHODS: Data on all Swiss HIV Cohort Study (SHCS) participants starting HCV protease inhibitor (PI) treatment between September 2011 and August 2013 were collected prospectively. The uptake and efficacy of HCV therapy were compared with those in the time period before the availability of PIs. RESULTS: Upon approval of PI treatment in Switzerland in September 2011, 516 SHCS participants had chronic HCV genotype 1 infection. Of these, 57 (11%) started HCV treatment during the following 2 years with either telaprevir, faldaprevir or boceprevir. Twenty-seven (47%) patients were treatment-naïve, nine (16%) were patients with relapse and 21 (37%) were partial or null responders. Twenty-nine (57%) had advanced fibrosis and 15 (29%) had cirrhosis. End-of-treatment virological response was 84% in treatment-naïve patients, 88% in patients with relapse and 62% in previous nonresponders. Sustained virological response was 78%, 86% and 40% in treatment-naïve patients, patients with relapse and nonresponders, respectively. Treatment uptake was similar before (3.8 per 100 patient-years) and after (6.1 per 100 patient-years) the introduction of PIs, while treatment efficacy increased considerably after the introduction of PIs. CONCLUSIONS: The introduction of PI-based HCV treatment in HIV/HCV-coinfected patients improved virological response rates, while treatment uptake remained low. Therefore, the introduction of PIs into the clinical routine was beneficial at the individual level, but had only a modest effect on the burden of HCV infection at the population level.
Subject(s)
Antiviral Agents/therapeutic use , HIV Infections/complications , Hepatitis C, Chronic/drug therapy , Patient Acceptance of Health Care/statistics & numerical data , Protease Inhibitors/therapeutic use , Adult , Aminoisobutyric Acids , Cohort Studies , Female , Humans , Leucine/analogs & derivatives , Male , Middle Aged , Oligopeptides/therapeutic use , Proline/analogs & derivatives , Proline/therapeutic use , Prospective Studies , Quinolines , RNA, Viral/analysis , Switzerland , Thiazoles/therapeutic use , Viral LoadABSTRACT
Two cats with Leishmania species infections were investigated. The first had been imported from Spain with a non-healing, ulcerated nodule on a hindleg. The presence of Leishmania species was detected by histopathology and pcr on samples of skin. The lesion was unresponsive to treatment with allopurinol for three months but the cat was treated successfully by removing the lesion surgically. The second cat had lived in both Spain and Switzerland, and had a history of recurrent skin lesions on its head and neck. A diagnosis of pemphigus foliaceus was made on the basis of histopathology, but Leishmania species serology (elisa) and pcr of skin were positive, leading to a diagnosis of a Leishmania species infection combined with pemphigus foliaceus.
