Chalouni, MathieuMathieuChalouniVan Santen, Daniela KDaniela KVan SantenBerenguer, JuanJuanBerenguerJarrin, InmaculadaInmaculadaJarrinMiro, José MJosé MMiroKlein, Marina BMarina BKleinYoung, JimJimYoungTorgersen, JessieJessieTorgersenRentsch, Christopher TChristopher TRentschGill, M JohnM JohnGillEpstein, Rachel LRachel LEpsteinLinas, BenjaminBenjaminLinasZangerle, RobertRobertZangerleSurial, BernardBernardSurialRauch, AndriAndriRauch0000-0001-5297-6062Touloumi, GiotaGiotaTouloumiPapadopoulos, AntoniosAntoniosPapadopoulosWittkop, LindaLindaWittkopVan Der Valk, MarcMarcVan Der ValkBoyd, AndersAndersBoydMonforte, Antonella d'ArminioAntonella d'ArminioMonfortePuoti, MassimoMassimoPuotiLogan, Roger WRoger WLoganRein, Sophia MSophia MReinHernán, Miguel AMiguel AHernánLodi, SaraSaraLodi2025-03-242025-03-242025-07-01https://boris-portal.unibe.ch/handle/20.500.12422/205829Objective People with HIV-HCV co-infection need antiretroviral treatment (ART) to suppress HIV and direct-acting antivirals (DAAs) to cure HCV. ART is typically prioritized, but delays in DAA initiation may increase the risk of liver-related events and HCV transmission to others.Design Target trial emulation with observational data collected in routine clinical practice from a collaboration of cohorts from Europe and North America.Methods We included DAA-naïve adults with HIV-HCV co-infection who achieved HIV virologic suppression (HIV RNA<50 copies/mL) after starting ART between 2013-2020. We 1) estimated the probability of not initiating DAAs at 6 and 36 months after HIV virologic suppression, and 2) emulated a target trial of early (≤6 months after HIV virological suppression) versus delayed (>6 months) DAA initiation and the 36-month risk of liver-related events (liver decompensation or hepatocellular carcinoma).Results Of 862 eligible individuals (median age 46 years; interquartile range 36 to 56), 14% were women, and 52% had a history of injection drug use. The 6 and 36-month probabilities of not initiating DAA were 58% (95% CI: 55, 61) and 24% (21, 27), respectively. The 36-month risk of liver-related events was 1.1% (0.4, 2.0) for early initiation and 1.7% (0.7, 2.5) for delayed initiation; risk difference -0.5% (-1.2, 0.4).Conclusions Almost one-quarter of people with HIV-HCV co-infection on ART had not initiated DAA 3 years after HIV virologic suppression. Because the 3-year risk of liver-related events was low, estimates of the impact of delayed DAA initiation were imprecise.en600 - Technology::610 - Medicine & healtharticle10.48620/865073997019210.1097/QAD.0000000000004161