Hepatitis C microelimination among people living with HIV in Taiwan

Abstract

To reach the WHO target of hepatitis C virus (HCV) elimination by 2025, Taiwan started to implement free-of-charge direct-acting antiviral (DAA) treatment programme in 2017. Evaluating the progress of HCV microelimination among people living with HIV (PLWH) is a critical step to identify the barriers to HCV elimination. PLWH seeking care at a major hospital designated for HIV care in Taiwan between January 2011 and December 2021 were retrospectively included. For PLWH with HCV-seropositive or HCV seroconversion during the study period, serial HCV RNA testing was performed using archived samples to confirm the presence of HCV viremia and estimate the prevalence and incidence of HCV viremia. Overall, 4199 PLWH contributed to a total of 27,258.75 person-years of follow-up (PYFU). With the reimbursement of DAAs and improvement of access to treatments, the prevalence of HCV viremia has declined from its peak of 6.21% (95% CI, 5.39–7.12%) in 2018 to 2.09% (95% CI, 1.60–2.77%) in 2021 (decline by 66.4% [95% CI, 55.4–74.7%]); the incidence has declined from 25.94 per 1000 PYFU (95% CI, 20.44–32.47) in 2019 to 12.15% per 1000 PYFU (95% CI, 8.14–17.44) (decline by 53.2% [95% CI, 27.3–70.6%]). However, the proportion of HCV reinfections continued to increase and accounted for 82.8% of incident HCV infections in 2021. We observed significant declines of HCV viremia among PLWH with the expansion of the DAA treatment programme in Taiwan. Further improvement of the access to DAA retreatments is warranted to achieve the goal of HCV microelimination.

In the fight against HIV/AIDS: the arduous implementation of government-funded pre-exposure prophylaxis programme in Taiwan

“…5 The number of people living with HIV (PLHIV) was 34 544 by the end of 2021 in Taiwan, with 90% of PLHIV knowing their HIV status, 94% receiving antiretroviral therapy (ART) and 95% of those receiving ART achieving viral suppression. 6 Sexual…”

“…The number of people living with HIV (PLHIV) was 34 544 by the end of 2021 in Taiwan, with 90% of PLHIV knowing their HIV status, 94% receiving antiretroviral therapy (ART) and 95% of those receiving ART achieving viral suppression. 6 Sexual transmission in men who have sex with men is the leading transmission route (83.6%), followed by heterosexual contact (9.1%) and injecting drugs (1.7%). 7 The introduction of the PrEP programme was recommended in a cross-ministerial meeting in 2015—the Committee for HIV Infection Control and Patient Rights Protection, held according to the HIV Infection Control and Patient Rights Protection Act.…”

Optimal Frequency of Hepatitis C Virus (HCV) RNA Testing for Detection of Acute HCV Infection Among At-risk People With Human Immunodeficiency Virus: A Multicenter Study

“…Hepatitis C virus (HCV) infection has emerged as a sexually transmitted infection (STI) among people with human immunodeficiency virus (PWH) in the past 2 decades worldwide [ 1 ]. Although highly effective direct-acting antiviral agents (DAAs) against HCV have successfully decreased the incidence and prevalence of HCV viremia among PWH [ 2 , 3 ], HCV reinfections continue to pose challenges to HCV microelimination [ 2 , 4 , 5 ]. PWH who are men who have sex with men (MSM) or have recently acquired HCV infection are at the highest risk of HCV reinfection following treatment [ 5 ].…”

Hepatitis C Virus Micro-elimination Among People With HIV in San Diego: Are We on Track?

“…Because screening for HCV is part of the HIV standard of care and many PWH already have access to health services through integrated models of care [ 5 ], many consider that PWH comprise a population where HCV elimination (micro-elimination) is feasible [ 5 ]. Indeed, some countries with universal health care systems have reported significant progress toward HCV micro-elimination among PWH [ 6 , 7 ]. Similar programs exist nationally, statewide, and county-wide in the United States.…”