A Treatment-as-Prevention Trial to Eliminate Hepatitis C Among Men Who Have Sex With Men Living With Human Immunodeficiency Virus (HIV) in the Swiss HIV Cohort Study

Abstract

Background In 2016, the World Health Organization (WHO) introduced global targets for the elimination of hepatitis C (HCV) by 2030. We conducted a nationwide HCV micro-elimination program among men who have sex with men (MSM) living with HIV from the Swiss HIV Cohort Study (SHCS) to test whether the WHO goals are achievable in this population. Methods During phase A (10/2015-06/2016), we performed a population-based and systematic screening for HCV-RNA among MSM from the SHCS. During phase B (06/2016-02/2017) we offered treatment with HCV direct-acting agents (DAAs) to MSM identified with a replicating HCV infection. During phase C (03/2017-11/2017), we offered re-screen to all MSM for HCV-RNA and initiated DAA treatment in MSM with replicating infections (Clinicaltrials.gov NCT02785666). Findings We screened 3’715/4'640 (80%) MSM and identified 177 with replicating HCV infections (4.8%); 150 (85%) of which started DAA treatment and 149 (99.3%) were cured. We re-screened 2’930/3'538 (83%) MSM with a prior negative HCV-RNA and identified 13 (0.4%) with a new HCV infection. At the end of the micro-elimination program, 176/190 MSM (93%) were cured, and the HCV incidence rate declined from 0.53 per 100 patient-years (95% confidence interval [CI] 0.35, 0.83) prior to the intervention to 0.12 (CI 0.03, 0.49) by the end of 2019. Interpretation A systematic and population-based HCV micro-elimination program among MSM living with HIV was feasible and resulted in a strong decline in HCV incidence and prevalence. Our study can serve as a model for other countries aiming to achieve the WHO HCV elimination targets.

HCV reinfection after HCV therapy among HIV/HCV‐coinfected individuals in Europe

“…Lower odds of reinfection among those treated in recent years can possibly be explained by a lower prevalence of HCV infection in the population due to the scale‐up of DAA since 2014. This is supported by an Australian study showing a low risk of reinfection following unrestricted access to DAA despite ongoing risk behaviour [6], and studies from Europe that have found a decrease in the incidence of primary HCV infection among HIV‐infected individuals after universal access to DAA [11,12].…”

HCV disease burden and population segments in Switzerland

“…17 By 2017, the prevalence of HCV in HIV + MSM was 0.8% in the cohort. 17 The number of HIV + MSM who use chemsex drugs, as well as the prevalence of HCV was available from a recent analysis of the Swiss HIV cohort. 18 The impact of HCV treatment efforts in the HIV + MSM population on the prevalence amongst HIV + MSM who use chemsex drugs is unknown.…”

The cost‐effectiveness of case‐finding strategies for achieving hepatitis C elimination among men who have sex with men in the UK

“…However, significant HCV infection resides in HIV‐negative MSM (1.2% prevalence in UK in 2008/2009), 7 especially among those on HIV pre‐exposure prophylaxis (2.1% in PROUD study) 8 . Although three recent European studies have demonstrated scaling‐up HCV treatment can result in substantial reductions (51%–77%) in HCV incidence among HIV‐positive MSM, 6,9,10 our modelling suggests that screening and treatment is also needed in HIV‐negative MSM to reach the HCV elimination targets among all MSM 11 …”