Microelimination of Hepatitis C Among People With Human Immunodeficiency Virus Coinfection: Declining Incidence and Prevalence Accompanying a Multicenter Treatment Scale-up Trial. (3rd October 2020)

• Record Type: Journal Article
• Authors: Doyle, Joseph S; van Santen, Daniela K; Iser, David; Sasadeusz, Joe; O'Reilly, Mark; Harney, Brendan; Traeger, Michael W; Roney, Janine; Cutts, Julia C; Bowring, Anna L; Winter, Rebecca; Medland, Nick; Fairley, Christopher K; Moore, Richard; Tee, B K; Asselin, Jason; El-Hayek, Carol; Hoy, Jennifer F; Matthews, Gail V; Prins, Maria; Stoové, Mark A; Hellard, Margaret E
• Is Part Of: Clinical infectious diseases. Volume 73:Number 7(2021)
• Page Start: e2164
• Page End: e2172
• Publication Date: 2020-10-03
• Subjects: hepatitis C -- elimination -- treatment -- HIV coinfection; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciaa1500
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: Gay and bisexual men (GBM) are a key population affected by human immunodeficiency virus (HIV) and hepatitis C virus (HCV) coinfection. We aimed to measure HCV treatment effectiveness and to determine the population impact of treatment scale-up on HCV prevalence and incidence longitudinally among GBM. Methods: The co-EC Study (Enhancing Care and Treatment Among HCV/HIV Coinfected Individuals to Eliminate Hepatitis C Transmission) was an implementation trial providing HCV direct-acting antiviral treatment in Melbourne, Australia, during 2016–2018. Individuals with HCV/HIV coinfection were prospectively enrolled from primary and tertiary care services. HCV viremic prevalence and HCV antibody/viremic incidence were measured using a statewide, linked, surveillance system. Results: Among 200 participants recruited, 186 initiated treatment during the study period. Sustained virological response in primary care (98% [95% confidence interval {CI}, 93%–100%]) was not different to tertiary care (98% [95% CI, 86%–100%]). From 2012 to 2019, between 2434 and 3476 GBM with HIV infection attended our primary care sites annually, providing 13 801 person-years of follow-up; 50%–60% received an HCV test annually, and 10%–14% were anti-HCV positive. Among those anti-HCV positive, viremic prevalence declined 83% during the study (54% in 2016 to 9% in 2019). HCV incidence decreased 25% annually from 1.7/100 person-years in 2012 to 0.5/100 person-years in 2019 (incidence rate ratio, 0.75 [95% CI, .68–.83]; P < .001). Conclusions: High treatment effectiveness by nonspecialists demonstrates the feasibility of treatment scale-up in this population. Substantial declines in HCV incidence and prevalence among GBM provides proof-of-concept for HCV microelimination. Clinical Trials Registration: NCT02786758. Abstract : The co-EC Study reports declining hepatitis C virus (HCV) incidence and prevalence among people living with human immunodeficiency virus (HIV) after prospectively scaling up treatment in hospital clinics and non–hepatitis specialist settings. It provides empirical evidence that HCV microelimination among people with HIV is achievable.