Establishing a hepatitis C continuum of care among HIV/hepatitis C virus‐coinfected individuals in EuroSIDA

Abstract

Objectives The aim of the study was to establish a methodology for evaluating the hepatitis C continuum of care in HIV/hepatitis C virus (HCV)‐coinfected individuals and to characterize the continuum in Europe on 1 January 2015, prior to widespread access to direct‐acting antiviral (DAA) therapy. Methods Stages included in the continuum were as follows: anti‐HCV antibody positive, HCV RNA tested, currently HCV RNA positive, ever HCV RNA positive, ever received HCV treatment, completed HCV treatment, follow‐up HCV RNA test, and cure. Sustained virological response (SVR) could only be assessed for those with a follow‐up HCV RNA test and was defined as a negative HCV RNA result measured > 12 or 24 weeks after stopping treatment. Results Numbers and percentages for the stages of the HCV continuum of care were as follows: anti‐HCV positive (n = 5173), HCV RNA tested (4207 of 5173; 81.3%), currently HCV RNA positive (3179 of 5173; 61.5%), ever HCV RNA positive (n = 3876), initiated HCV treatment (1693 of 3876; 43.7%), completed HCV treatment (1598 of 3876; 41.2%), follow‐up HCV RNA test to allow SVR assessment (1195 of 3876; 30.8%), and cure (629 of 3876; 16.2%). The proportion that achieved SVR was 52.6% (629 of 1195). There were significant differences between regions at each stage of the continuum (P < 0.0001). Conclusions In the proposed HCV continuum of care for HIV/HCV‐coinfected individuals, we found major gaps at all stages, with almost 20% of anti‐HCV‐positive individuals having no documented HCV RNA test and a low proportion achieving SVR, in the pre‐DAA era.

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

“…Among our study population, one PWID presented with acute HCV infection at BL and showed persisting viraemia at FU. Although the overall test rate in our population was high, this goes in line with recently published findings from the EuroSIDA cohort, where in almost 20% of anti‐HCV(+) individuals no subsequent HCV‐RNA PCR was performed and only a low proportion of HIV/HCV coinfected patients achieved SVR …”

“…Since the termination of this study, interventions to increase linkage to care for HIV/HCV coinfected patients have been intensified in Vienna 47 and future data analyses will assess the epidemiological impact of these HCV microelimination strategies. Furthermore, similar to the EuroSIDA report,40 our observations are not limited to but also include time periods from the pre-DAA era. Since then, the reimbursement limitations for HCV DAA therapy was eliminated and modern pangenotypic DAA regimens have been available, which will most likely impact HCV epidemiology in Austria.While this study is limited by the lack of a standardized HCV testing protocol and some patients being lost to FU, our epidemiological results are essential for future HCV microelimination projects targeting the specific population of HIV+ individuals in Vienna and other parts of Austria.…”

“…Since the termination of this study, interventions to increase linkage to care for HIV/HCV coinfected patients have been intensified in Vienna and future data analyses will assess the epidemiological impact of these HCV microelimination strategies. Furthermore, similar to the EuroSIDA report, our observations are not limited to but also include time periods from the pre‐DAA era. Since then, the reimbursement limitations for HCV DAA therapy was eliminated and modern pangenotypic DAA regimens have been available, which will most likely impact HCV epidemiology in Austria.…”

The EuroSIDA study: 25 years of scientific achievements

“…In total, around a quarter of all HIV/HCV co-infected individuals in EuroSIDA received anti-HCV treatment between 1998-2010, with an increasing trend over time and marked regional differences in the uptake of anti-HCV therapy across Europe [37]. Ongoing work aims to establish the continuum of HCV care, to monitor short-term and long-term uptake, efficacy, and adverse events to DAAs across Europe, and to monitor long-term risk of liver disease and other clinical outcomes [38,39].…”

Excess liver‐related mortality among people with AIDS compared to the general population: an Italian nationwide cohort study using multiple causes of death

“…Enforcing preventive strategies targeted to limiting the burden of these infections, including actively offering serological testing for HBV and HCV and HBV vaccination, could contribute to reduction of liver‐related mortality, especially among injecting drug users [40,41] and younger PWA. Furthermore, the introduction since 2015 of effective direct‐acting antivirals to treat HCV infection is expected to be particularly effective in reducing its prevalence, provided that barriers to test‐and‐treat are removed and a continuum of care is established among HCV/HIV‐coinfected individuals [42]. The follow‐up of individuals under HCV treatment should focus on medication compliance, side‐effect monitoring, and drug interaction management.…”