Moving Towards HCV Elimination Among People Living with HIV in Australia: Analysis of the CEASE Prospective Cohort Study

Abstract

Background: HCV elimination among people living with HIV may be feasible in Australia, given unrestricted access to direct-acting antiviral (DAA) therapy (from March 2016). Our aim was to evaluate HCV treatment uptake, outcome, and HCV RNA prevalence among HIV/HCV co-infected adults in Australia following the availability of DAA therapy. Methods: The Control and Elimination of HCV from HIV-infected individuals within Australia (CEASE) prospective cohort study enrolled adults with HIV and current (HCV RNA positive) or past (anti-HCV antibody positive, HCV RNA negative) HCV infection from 14 primary and tertiary clinics. Cumulative and annual HCV treatment uptake, outcome, and HCV RNA prevalence was evaluated, with follow up through May 2018 (median follow-up: 2.63 years, IQR 1.96, 3.20). Factors associated with DAA uptake were analysed using Cox regression. Findings: Between July 2014 and March 2017, 402 HIV/HCV antibody-positive participants were enrolled (95% male [80% gay and bisexual men], 13% cirrhosis, 79% history of injecting drug use [39% current injecting]). Cumulative HCV treatment uptake among those ever eligible was 91% (336/371). Annual HCV treatment uptake increased from 7% and 11% per year in 2014 and 2015, to 80% and 35% per year in 2016 and 2017, respectively. HCV viraemic prevalence declined from 82% in 2014 to 8% in 2018. Interpretation: High uptake and effectiveness of unrestricted government-subsidised DAA therapy has permitted rapid treatment scale-up, with a dramatic reduction in HCV infection burden among people living with HIV in Australia, suggesting that elimination within this population is feasible. Clinical Trial Number: The study was registered with ClinicalTrials.gov (NCT02102451). Funding Statement: The Kirby Institute is funded by the Australian Government Department of Health and Ageing. The views expressed in this publication do not necessarily represent the position of the Australian Government. Research reported in this publication was supported by Gilead Sciences Inc as an investigator-initiated study. The content is solely the responsibility of the authors. Declaration of Interests: None of the authors had commercial relationships that might pose a conflict of interest in connection with this manuscript. Ethics Approval Statement: All study participants provided written informed consent before study procedures. The study protocol was approved by St Vincent’s Hospital, Sydney Human Research Ethics Committee (primary study committee) and was conducted according to the Declaration of Helsinki and International Conference on Harmonization Good Clinical Practice (ICH/GCP) guidelines and local regulatory requirements.