Abstract
ObjectivesThe Belgian population of people living with HIV (PLHIV) has unrestricted access to direct-acting antiviral (DAA) treatment for hepatitis C virus (HCV) infection, since 2017. International literature claims that half of the patients remain untreated in high-income countries with unrestricted access to DAA. This study was initiated to provide an overview of the present situation in Belgium and recommendations for HCV care in PLHIV in other regions. MethodsThis was a retrospective, multicenter study of PLHIV in Belgium, from January 1, 2007 to December 31, 2018. The HCV cascade of care was examined. ResultsOut of 4607 unique PLHIV, 322 (7.0%) tested positive for HCV antibody and HCV RNA positivity was seen in 289 (6.3%). Of those with a proven HCV infection, 207/289 (71.6%) initiated treatment. Of the 171 (82.6%) persons with a sustained virologic response (SVR), 16 (9.4%) subjects were reinfected. ConclusionsWe present a care cascade of 4607 PLHIV in Belgium. Treatment initiation and SVR rates were high compared to other regions. Implementation of a national HCV register to track progress and yearly screening, especially in PLHIV with high-risk behavior, remains crucial. Identifying reasons for not initiating treatment is necessary to achieve elimination of HCV in PLHIV by 2030.
Highlights
2–3 million new hepatitis C virus (HCV) infections are estimated to occur annually (WHO, 2017)
FibroScan1 scores were available for 148/322 (46.0%) patients, and HCV genotype was identified in 248/289 (85.8%) of the patients with HCV infection (Table 1)
A substantial number (7.0%) of this study population was found positive for HCV Ab and 6.3% for HCV RNA
Summary
2–3 million new hepatitis C virus (HCV) infections are estimated to occur annually (WHO, 2017). The majority of patients have been iatrogenically infected, with the two most important risk groups for HCV infection being people who inject drugs (PWID) and people living with HIV (PLHIV) (Busschots et al., 2020). More than 6% of PLHIV is coinfected with HCV (Platt et al, 2016). According to a recent European review, HCV antibody (Ab) prevalence in PLHIV ranged from 2.9% to 43.4% (Mason et al, 2019). HCV Ab and RNA prevalence in the Belgian population is relatively low (1.0% and 0.3%, respectively), though there are no reasonable estimates of HCV prevalence in PLHIV (Muyldermans et al, 2019). 89.0% were diagnosed and 11.0% were assumed to be unaware of their HIV serostatus (Sasse et al, 2018)
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