Micro-elimination of HIV and HCV co-infection

Abstract

More than 2 million people are co-infected with HIV and hepatitis C virus (HCV). 1 Platt L Easterbrook P Gower E et al. Prevalence and burden of HCV co-infection in people living with HIV: a global systematic review and meta-analysis. Lancet Infect Dis. 2016; 16: 797-808 Summary Full Text Full Text PDF PubMed Scopus (379) Google Scholar Co-infection with these persistent virus infections poses a threat: over the past decade an increased prevalence of HCV infection has occurred in men who have sex with men (MSM) with HIV in Europe. 2 van Santen DK van der Helm JJ Del Amo J et al. Lack of decline in hepatitis C virus incidence among HIV-positive men who have sex with men during 1990–2014. J Hepatol. 2017; 67: 255-262 Summary Full Text Full Text PDF PubMed Scopus (44) Google Scholar Historically, shared transmission occurred in people who inject drugs (PWID); transfusions of infected blood products caused devastating outcomes for co-infected haemophiliacs. 3 Darby SC Ewart DW Giangrande PL et al. Mortality from liver cancer and liver disease in haemophilic men and boys in UK given blood products contaminated with hepatitis C. Lancet. 1997; 350: 1425-1431 Summary Full Text Full Text PDF PubMed Scopus (497) Google Scholar Early reports indicated an increased risk of progressive liver disease after dual infection. Effective antiretroviral therapy reduced mortality from HIV, but the poor effectiveness of interferon-α treatment on HCV and HIV co-infection accentuated a relative increase in liver-related morbidity. 4 Martin-Carbonero L Soriano V Valencia E Garcia-Samaniego J Lopez M Gonzalez-Lahoz J Increasing impact of chronic viral hepatitis on hospital admissions and mortality among HIV-infected patients. AIDS Res Hum Retroviruses. 2001; 17: 1467-1471 Crossref PubMed Scopus (205) Google Scholar , 5 Sulkowski MS Mehta SH Torbenson MS et al. Rapid fibrosis progression among HIV/hepatitis C virus-co-infected adults. AIDS. 2007; 21: 2209-2216 Crossref PubMed Scopus (158) Google Scholar Highly effective direct-acting antiviral (DAA) treatments now effect high rates of HCV cure in co-infected patients. 6 Wyles D Saag M Viani RM et al. TURQUOISE-I part 1b: ombitasvir/paritaprevir/ritonavir and dasabuvir with ribavirin for hepatitis c virus infection in hiv-1 coinfected patients on darunavir. J Infect Dis. 2017; 215: 599-605 Crossref PubMed Scopus (21) Google Scholar The concept of micro-elimination uses testing and treatment strategies in defined populations to decrease incidence. Thus, micro-elimination of HCV in people living with HIV is an obvious objective as these individuals in HIV care are an easy to reach group and because of the risk of onward transmission and the potentially deleterious outcomes of unrecognised coinfection. 7 Bischoff J Rockstroh JK Are there any challenges left in hepatitis C virus therapy of HIV-infected patients?. Int J Antimicrob Agents. 2020; 56105527 Crossref PubMed Scopus (3) Google Scholar HCV micro-elimination in individuals with HIV in the Netherlands 4 years after universal access to direct-acting antivirals: a retrospective cohort studyThe sharp decline in HCV incidence in MSM with HIV shortly after restrictions on DAAs were lifted suggests a treatment-as-prevention effect. HCV incidence was already low in PWID and other groups before unrestricted access. Ongoing HCV transmission is occurring in MSM, as illustrated by a declining but high rate of reinfection, stressing the need for additional preventive measures. Full-Text PDF