Increased case-finding and uptake of direct-acting antiviral treatment essential for micro-elimination of hepatitis C among people living with HIV: a national record linkage study.

A Mcleod,Pc Hayes,St Barclay,La Wallace,K Templeton,P Bramley,N Kennedy,A Mcauley,E Peters,Dj Goldberg,S Smith,Sj Hutchinson,Jf Dillon,S Clifford,C Leen,Rn Gunson,A Fraser

doi:10.1111/hiv.13032

Abstract

Micro-elimination of hepatitis C virus (HCV) in people living with HIV (PLHIV) and co-infected with HCV has been proposed as a key contribution to the overall goal of HCV elimination. While other studies have examined micro-elimination in HIV-treated cohorts, few have considered HCV micro-elimination among those not treated for HIV or at a national level. Through data linkage of national and sentinel surveillance data, we examined the extent of HCV testing, diagnosis and treatment among a cohort of PLHIV in Scotland identified through the national database of HIV-diagnosed individuals, up to the end of 2017. Of 5018 PLHIV, an estimated 797 (15%) had never been tested for HCV and 70 (9%) of these had undiagnosed chronic HCV. The odds of never having been tested for HCV were the highest in those not on HIV treatment [adjusted odds ratio (aOR)=7.21, 95% confidence interval (CI): 5.15-10.10). Overall HCV antibody positivity was 11%, and it was at its highest among people who inject drugs (49%). Most of those with chronic HCV (91%) had attended an HCV treatment clinic but only half had been successfully treated (54% for those on HIV treatment, 12% for those not) by the end of 2017. The odds of never having been treated for HCV were the highest in those not on HIV treatment (aOR=3.60, 95% CI: 1.59-8.15). Our data demonstrate that micro-elimination of HCV in PLHIV is achievable but progress will require increased effort to engage and treat those co-infected, including those not being treated for their HIV.

Highlights

Since the introduction of Direct Acting Antiviral (DAA) treatment for hepatitis C virus (HCV) infection, with shorter treatment duration and cure rates exceeding 95%, elimination of the virus is possible.[1,2] The World Health Organization (WHO) has set the goal of reducing HCV mortality by 65% and new chronic HCV infections by 80% by 2030.[3,4] Micro-elimination of HCV in key populations has been proposed as a pragmatic approach to the overall elimination goal.[5]
A key population for micro-elimination is people living with HIV (PLHIV) and co-infected with HCV. [7,8]
The Scottish Government has recently committed to elimination of hepatitis C as a public health concern in Scotland by 2024.[19]. In 2018, the British HIV Association (BHIVA) recommended an accelerated effort to eliminate HCV among people living with HIV with targets to cure 80% of all co-infected patients by 2019 increasing to 100% by 2021.[14]. Utilising a variety of surveillance initiatives for blood borne viruses in Scotland, this is the first study to examine progress towards microelimination of HCV among PLHIV at a national level, including estimating the extent of undiagnosed infection

Summary

Introduction

Since the introduction of Direct Acting Antiviral (DAA) treatment for hepatitis C virus (HCV) infection, with shorter treatment duration and cure rates exceeding 95%, elimination of the virus is possible.[1,2] The World Health Organization (WHO) has set the goal of reducing HCV mortality by 65% and new chronic HCV infections by 80% by 2030.[3,4] Micro-elimination of HCV in key populations has been proposed as a pragmatic approach to the overall elimination goal.[5]. A key population for micro-elimination is people living with HIV (PLHIV) and co-infected with HCV. Of the estimated 36.9 million PLHIV worldwide, 2.3 million (6.2%) are HCV antibody positive.[9] The prevalence of HCV antibody positivity varies significantly by risk group, ranging from 6.5% among HIV infected men who have sex with men (MSM) to 82.4% among HIV infected people who inject drugs (PWID).[10] The 2015 European Association for the Study of the Liver (EASL) recommendations on treatment of HCV prioritised DAA therapy for HCV/HIV co-infected individuals, regardless of fibrosis stage, due to drug interactions between anti-retroviral therapy and interferon-based HCV treatments.[11] Treatment in co-infected PLHIV with DAA therapy has been shown to be as highly effective as for HCV mono-infected patients. Treatment in co-infected PLHIV with DAA therapy has been shown to be as highly effective as for HCV mono-infected patients. [12,13] More recently, the British HIV

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