Epidemiological trends in HCV transmission and prevalence in the Viennese HIV+ population

Abstract

Background & Aims Human immunodeficiency virus (HIV)/hepatitis C virus (HCV) coinfection is common in people who inject drugs (PWIDs). Recently, ‘high‐risk’ behaviour among men who have sex with men (MSM) has emerged as another main route of HCV transmission. We analysed temporal trends in HCV epidemiology in a cohort of Viennese HIV+ patients. Methods Hepatitis C virus parameters were recorded at HIV diagnosis (baseline [BL]) and last visit (follow‐up [FU]) for all HIV+ patients attending our HIV clinic between January 2014 and December 2016. Proportions of HIV+ patients with anti‐HCV(+) and HCV viraemia (HCV‐RNA(+)) at BL/FU were assessed and stratified by route of transmission. Results In all, 1806/1874 (96.4%) HIV+ patients were tested for HCV at BL. Anti‐HCV(+) was detected in 93.2% (276/296) of PWIDs and in 3.7% (31/839) of MSM. After a median FU of 6.9 years, 1644 (91.0%) patients underwent FU HCV‐testing: 167 (90.3%) of PWIDs and 49 (6.7%) of MSM showed anti‐HCV(+). Among 208 viraemic HCV‐RNA(+) patients at BL, 30 (14.4%) had spontaneously cleared HCV, 76 (36.5%) achieved treatment‐induced eradication and 89 (42.8%) remained HCV‐RNA(+) at last FU. Among 1433 initially HCV‐naive patients, 45 (3.5%) acquired de‐novo HCV infection (11.1% PWIDs/80.0% MSM; incidence rate (IR) 0.004%; 95% confidence interval [CI] 0.0%‐0.022%) and 14 had HCV reinfections (85.7% PWIDs/14.3% other; IR 0.001%; 95% CI 0.0%‐0.018%) during a median FU of 6.7 years (interquartile range 7.4). Conclusion Hepatitis C virus testing was successfully implemented in the Viennese HIV(+) patients. Anti‐HCV(+) prevalence remained stable in HIV+ PWIDs but almost doubled in HIV+ MSM. De‐novo HCV infection occurred mostly in MSM, while HCV reinfections were mainly observed in PWIDs. HCV treatment uptake was suboptimal with 42.8% remaining HCV‐RNA(+) at FU.

Directly observed therapy at opioid substitution facilities using sofosbuvir/velpatasvir results in excellent SVR12 rates in PWIDs at high risk for non-adherence to DAA therapy

“…However, HCV prevalence remains high among the 8.000 PWIDs in Vienna who are included in the nationwide OAT program. Therefore, measures targeting this subgroup need to be applied in order to reduce HCV-transmission [ 14 ].…”

“…Numerous phase III studies investigating the effectiveness of pangenotypic DAA have been performed recently [ 22 ]. PWIDs–and especially those with ongoing injection drug use (IDU)—were mostly excluded from these studies, however, this subpopulation represents one of the most important risk groups for HCV infection and transmission, especially because they are often unaware of their HCV-infection [ 14 , 15 , 17 , 41 – 43 ]. Psychiatric comorbidities and unstable socioeconomic circumstances are common in PWIDs—especially those with ongoing IDU.…”

Outcomes of an HCV elimination program targeting the Viennese MSM population

“…Over the last years the proportion of hepatitis C virus (HCV) patients with MSM (men-who-have-sex-with men) as the main transmission route has considerably increased in Vienna [ 1 , 2 ]. Recently, the proportion of MSM accounted for about 30–40% of patients presenting with untreated HCV infection at our human immunodeficiency virus (HIV)/hepatitis outpatient clinic at the Vienna General Hospital (VGH).…”

Epidemiological trends of HBV and HDV coinfection among Viennese HIV+ patients

“…Austria represents a low‐prevalence country for HBV monoinfection as well as for HIV/HBV and HBV/HDV coinfection, 3,4 but recent immigration trends and emerging local risk groups may have changed the national epidemiology of HBV infection. While people who inject drugs (PWIDs) used to represent the majority of the Austrian people living with HIV, recent epidemiological analyses identified new risk groups for HIV and viral hepatitis infection, such as men who have sex with men (MSM) 3,5 …”