Low utilization of direct-acting antiviral agents in a large national cohort of HIV and HCV co-infected Medicare patients in the United States: Implications for HCV elimination

HCV infection is common in people living with HIV/AIDS (PLWHA). The advent of direct-acting antiviral agents (DAAs) has made HCV elimination a realistic goal. We conducted a retrospective cohort study using the U.S. Medicare Fee-For-Service claims data and outpatient prescription drug data to assess the HCV DAA initiation and completion among newly diagnosed HIV-HCV co-infected Medicare patients enrolled in 2014–2016. DAA initiation was defined as filling at least one prescription of DAAs during 2014–2016. DAA completion was defined as taking an 8-week or longer DAA treatment course for patients without cirrhosis and a 12-week or longer treatment duration for those with cirrhosis. Among 12,152 HIV-HCV co-infected Medicare patients, 20.9% received the DAA treatment in 2014–2016. The average time from HCV diagnosis to DAA initiation was 277 days. The overall DAA completion rate was 92% among 2,537 patients who used DAAs. Interventions are needed to improve DAA uptake in PLWHA