Abstract
BackgroundHCV treatment uptake has drastically increased in HIV-HCV coinfected patients in France since direct-acting antiviral (DAA) treatment approval, resulting in HCV cure in 63% of all HIV-HCV patients by the end of 2015. We investigated the impact of scaling-up DAA on HCV prevalence in the whole HIV population and in various risk groups over the next 10 years in France using a transmission dynamic compartmental model.MethodsThe model was based on epidemiological data from the French Dat’AIDS cohort. Eight risk groups were considered, including high-risk (HR) and low-risk (LR) men who have sex with men (MSM) and male/female heterosexuals, intra-venous drug users, or patients from other risk groups. The model was calibrated on prevalence and incidence data observed in the cohort between 2012 and 2015.ResultsOn January 1, 2016, 156,811 patients were registered as infected with HIV in France (24,900 undiagnosed patients) of whom 7938 (5.1%) had detectable HCV-RNA (722 undiagnosed patients). Assuming a treatment coverage (TC) rate of 30%/year (i.e., the observed rate in 2015), model projections showed that HCV prevalence among HIV patients is expected to drop to 0.81% in 2026. Sub-analyses showed a similar decrease of HIV-HCV prevalence in most risk groups, including LR MSM. Due to higher infection and reinfection rates, predicted prevalence in HR MSM remained stable from 6.96% in 2016 to 6.34% in 2026. Increasing annual TC rate in HR MSM to 50/70% would decrease HCV prevalence in this group to 2.35/1.25% in 2026. With a 30% TC rate, undiagnosed patients would account for 34% of HCV infections in 2026.ConclusionsOur model suggests that DAA could nearly eliminate coinfection in France within 10 years for most risk groups, including LR MSM. Elimination in HR MSM will require increased TC.
Highlights
hepatitis C virus (HCV) treatment uptake has drastically increased in human immunodeficiency virus (HIV)-HCV coinfected patients in France since directacting antiviral (DAA) treatment approval, resulting in HCV cure in 63% of all HIV-HCV patients by the end of 2015
We explored the impact of potential behavioral changes over the 10 years among high-risk men who have sex with men (MSM) on HIV-HCV prevalence by considering a linear increase in the proportion of HIV monoinfected high-risk MSM
HIV-HCV patients in France On January 1, 2016, 156,811 patients were estimated to be infected with HIV in France, of whom 24,900 (16%) were part of the undiagnosed population [19]
Summary
HCV treatment uptake has drastically increased in HIV-HCV coinfected patients in France since directacting antiviral (DAA) treatment approval, resulting in HCV cure in 63% of all HIV-HCV patients by the end of 2015. Recent studies reported that, among HIV-infected men who have sex with men (MSM), HCV reinfection rates are alarmingly high and that specific strategies, such as frequent HCV RNA testing, were more needed for this risk group [9,10,11,12]. Of note, such alarming HCV reinfection incidence rates have not been reported far for other risk groups. Recent modeling studies focusing on the MSM population showed that, despite high DAA treatment rates, the HCV epidemic would continue unless more effective behavioral interventions were undertaken in this population [13, 14]
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