Time to direct-acting antiviral initiation and liver-related events in people with HIV and hepatitis C virus
Bibliographic record
Abstract
OBJECTIVE: People with HIV-hepatitis C virus (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-naive adults with HIV-HCV co-infection who achieved HIV virologic suppression (HIV RNA <50 copies/ml) after starting ART between 2013 and 2020. We estimated the probability of not initiating DAAs at 6 and 36 months after HIV virologic suppression and 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 36-56), 14% were women, and 52% had a history of injection drug use. The 6-month and 36-month probabilities of not initiating DAA were 58% [95% confidence interval (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 to 0.4). CONCLUSION: 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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".