Abstract
BackgroundDespite the availability of highly effective direct-acting antivirals (DAAs) and the expected treatment as prevention (TasP) effect, transmission of hepatitis C virus (HCV) persists in men who have sex with men (MSM) who engage in high-risk sexual behaviours.AimWe aimed to estimate the incidence of primary HCV infection among MSM living with HIV in France when DAA was readily available.MethodsWe used data from a large French hospital cohort of persons living with HIV (ANRS CO4-FHDH) prospectively collected between 2014 and 2017. HCV incidence rates were calculated using person-time methods for HCV-negative MSM at inclusion who had serological follow-up from 1 January 2014 to 31 December 2017. Sensitivity analyses were performed by varying the main assumptions to assess their impact on the results.ResultsOf 14,273 MSM living with HIV who were initially HCV-seronegative, 330 acquired HCV during follow-up over 45,866 person-years (py), resulting in an overall estimated incidence rate of 0.72/100 py (95% CI: 0.65–0.80). HCV incidence significantly decreased from 0.98/100 py (95% CI: 0.81–1.19) in 2014 to 0.45/100 py (95% CI: 0.35–0.59) in 2017 (54% decrease; 95% CI: 36–67). This trend was confirmed by most of the sensitivity analyses.ConclusionThe primary incidence of HCV was halved for MSM living with HIV between 2014 and 2017. This decrease may be related to unrestricted DAA availability in France for individuals living with HIV. Further interventions, including risk reduction, are needed to reach HCV micro-elimination in MSM living with HIV.
Highlights
Since 2000, hepatitis C virus (HCV) infection has emerged as an epidemic among men who have sex with men (MSM) living with HIV, especially in highincome countries [1,2,3]
Using data from the international CASCADE collaboration, van Santen et al found that HCV incidence among MSM living with HIV significantly increased between 1990 and 2014, there were some geographical variations within Europe [4]
The advent of highly effective, direct-acting antiviral (DAA) therapy for HCV, which is well tolerated, has a shorter treatment duration, and a sustained viral response (SVR) that exceeds 90% in both HCV monoinfected and HIV/HCV coinfected populations [13,14] raises the possibility of HCV elimination
Summary
Since 2000, hepatitis C virus (HCV) infection has emerged as an epidemic among men who have sex with men (MSM) living with HIV, especially in highincome countries [1,2,3]. The advent of highly effective, direct-acting antiviral (DAA) therapy for HCV, which is well tolerated, has a shorter treatment duration, and a sustained viral response (SVR) that exceeds 90% in both HCV monoinfected and HIV/HCV coinfected populations [13,14] raises the possibility of HCV elimination In this context, the World Health Organization (WHO) has issued HCV elimination targets that include a 90% reduction in HCV incidence by 2030 (relative to 2015) [15], a target that France has set for 2025 [16]. Despite the availability of highly effective direct-acting antivirals (DAAs) and the expected treatment as prevention (TasP) effect, transmission of hepatitis C virus (HCV) persists in men who have sex with men (MSM) who engage in high-risk sexual behaviours. Further interventions, including risk reduction, are needed to reach HCV micro-elimination in MSM living with HIV
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