Ently been expressed that the relatively high efficacy of hepatitis treatment reported in clinical trials is not attained in subsequent effectiveness LY-2409021 chemical information studies carried out in the general population under programmatic conditions [54]. In comparison to routine programmes, JW-74 patients in clinical trials tend to be more adherent to treatment, and will usually receive treatment free of charge provided by highly motivated clinical staff working in optimal clinical settings [55]. Nevertheless, this review found that programmatic outcomes were in very close alignment to a systematic review of outcomes in clinical trials, 1531364 which found that HCV treatment responses in HIV co-infected patients is lower than those observed in 23115181 HIV-negative individuals [56]. Nevertheless, for HIV-positive patients infected with HCV genotypes 2 or 3, treatment outcomes are very similar (SVR 60 ) to thoseResults887 articles were screened, and 103 of these were reviewed in full (figure 1). After identification of further papers which did not meet the inclusion criteria (e.g. studies that included retreated patients or studies that did not report treatment outcomes in full), we retained 77 studies for detailed review. Over half of these studies (37) were from Spain, and after correspondence with authors, 37 studies were excluded as partial or complete duplicate cohorts [13?2]. The final analysis included data on 5339 patients from 40 studies in 17 countries (Table 1). The proportion of patients with liver damage at baseline ranged from 12.5 to 74 . The majority of studies (36) included a mix of HCV genotypes. Three studies (from Argentina, Spain and the USA) were exclusively comprised of patients infected with genotypes 1 and 4 and two studies (from Sweden and Spain)Outcomes of Patients Co-Infected with HCV and HIVFigure 1. Identification of studies for inclusion. doi:10.1371/journal.pone.0055373.greported for HIV-negative HCV patients infected with the same genotypes in programme settings (SVR 59 ) [7]. Treatment completion was generally high, with few patients discontinuing treatment due to adverse events or defaulting from care. The use of HAART was not associated with better outcomes, which is consistent with other studies [57,58]. We used a broad search strategy that allowed the inclusion of a large number of studies. We restricted studies to observational cohorts so that the expected outcomes would better reflect those observed in programmatic settings, but this can result in confounding. Concomitant use of medications, unreported mental or physical problems, or ancillary health service support could allinfluence treatment outcomes, but these factors were not reported and so could not be assessed. We attempted to use multivariate meta-regression to explore the potential influence of patient and programme level variables to explain differences in results between studies. However, this was restricted by inconsistent reporting between studies, so our exploration of associations was limited to univariate subgroup comparisons. In addition, bias may result from studies that pre-selected patients on the basis of characteristics that may influence treatment success, or excluded patients with risk factors for poor adherence. Furthermore, the final analysis only included studies published in English, which may lead to publication bias. Only five studies, however, were excludedTable 1. Characteristics of included studies.Patient Characteristics Study setting Genotype 1/4:55.8 ; 2/3.Ently been expressed that the relatively high efficacy of hepatitis treatment reported in clinical trials is not attained in subsequent effectiveness studies carried out in the general population under programmatic conditions [54]. In comparison to routine programmes, patients in clinical trials tend to be more adherent to treatment, and will usually receive treatment free of charge provided by highly motivated clinical staff working in optimal clinical settings [55]. Nevertheless, this review found that programmatic outcomes were in very close alignment to a systematic review of outcomes in clinical trials, 1531364 which found that HCV treatment responses in HIV co-infected patients is lower than those observed in 23115181 HIV-negative individuals [56]. Nevertheless, for HIV-positive patients infected with HCV genotypes 2 or 3, treatment outcomes are very similar (SVR 60 ) to thoseResults887 articles were screened, and 103 of these were reviewed in full (figure 1). After identification of further papers which did not meet the inclusion criteria (e.g. studies that included retreated patients or studies that did not report treatment outcomes in full), we retained 77 studies for detailed review. Over half of these studies (37) were from Spain, and after correspondence with authors, 37 studies were excluded as partial or complete duplicate cohorts [13?2]. The final analysis included data on 5339 patients from 40 studies in 17 countries (Table 1). The proportion of patients with liver damage at baseline ranged from 12.5 to 74 . The majority of studies (36) included a mix of HCV genotypes. Three studies (from Argentina, Spain and the USA) were exclusively comprised of patients infected with genotypes 1 and 4 and two studies (from Sweden and Spain)Outcomes of Patients Co-Infected with HCV and HIVFigure 1. Identification of studies for inclusion. doi:10.1371/journal.pone.0055373.greported for HIV-negative HCV patients infected with the same genotypes in programme settings (SVR 59 ) [7]. Treatment completion was generally high, with few patients discontinuing treatment due to adverse events or defaulting from care. The use of HAART was not associated with better outcomes, which is consistent with other studies [57,58]. We used a broad search strategy that allowed the inclusion of a large number of studies. We restricted studies to observational cohorts so that the expected outcomes would better reflect those observed in programmatic settings, but this can result in confounding. Concomitant use of medications, unreported mental or physical problems, or ancillary health service support could allinfluence treatment outcomes, but these factors were not reported and so could not be assessed. We attempted to use multivariate meta-regression to explore the potential influence of patient and programme level variables to explain differences in results between studies. However, this was restricted by inconsistent reporting between studies, so our exploration of associations was limited to univariate subgroup comparisons. In addition, bias may result from studies that pre-selected patients on the basis of characteristics that may influence treatment success, or excluded patients with risk factors for poor adherence. Furthermore, the final analysis only included studies published in English, which may lead to publication bias. Only five studies, however, were excludedTable 1. Characteristics of included studies.Patient Characteristics Study setting Genotype 1/4:55.8 ; 2/3.
