Treatment of Early Hepatitis C Infection in HIV-Infected Men—When to Treat, Whom, and with What?

Abstract

There has been an expanding international epidemic of sexually transmitted hepatitis C virus (HCV) infection among HIV-infected men who have sex with men (MSM) since the turn of the twenty-first century, resulting in a progressively increasing number of these men presenting with early HCV infection in need of treatment. We and others have recently performed studies using short-course treatment with direct-acting antiviral (DAA) regimens in patients with early HCV infection that found similar or better cure rates compared to historical studies treating patients with chronic HCV. These studies provide further evidence that there is an enhanced treatment responsiveness period in early HCV infection. Ironically, since the introduction of truly safe and effective interferon-free DAA regimens, these treatments have become more difficult to obtain apparently due to higher costs, not of the price per cure, but because more people now want treatment. Prompt rather than delayed administration of treatment could further decrease the primary and re-infection rates among MSM by shortening the duration of infectiousness of these newly infected men. Since early and effective treatment of HCV infection is one of the essential elements in combating this epidemic and decreasing the number of new infections, and since short-course therapy, which is highly effective only in early HCV infection, is less expensive, we should be treating these patients immediately in this newly cost hyper-sensitive environment. We therefore urge that treatment guidelines be changed to reflect these rational arguments. Such guideline changes would additionally serve to push funding agencies to provide better access to treatment for early HCV infection.