Low hepatitis C virus-viremia prevalence yet continued barriers to direct-acting antiviral treatment in people living with HIV in the Netherlands

Abstract

van der Valk b,c , on behalf of the ATHENA observational cohort Objective: To describe hepatitis C virus (HCV)-viremia prevalence and barriers to direct-acting antiviral (DAA) treatment during unrestricted access to DAA in a nationwide cohort of people with HIV (PWH).Design: Retrospective analysis of prospectively collected data. Methods:We calculated yearly HCV-viremia prevalence as proportion of HCV RNApositive individuals ever HCV-tested. We then included HCV-viremic individuals with 1 visit during the era of universal DAA-access (database lock ¼ December 31, 2018). Based on their last visit, individuals were grouped as DAA-treated or -untreated. Variables associated with lack of DAA-treatment were assessed using targeted maximum likelihood estimation. In November 2020, physicians of DAA-untreated individuals completed a questionnaire on barriers to DAA-uptake and onward HCV-transmission risk.Results: Among 25 196 PWH, HCV-viremia decreased from 4% to 5% between 2000 and 2014 to 0.6% in 2019. Being DAA-untreated was associated with HIV-transmission route other than men who have sex with men, older age, infrequent follow-up, severe alcohol use, detectable HIV-RNA, HCV-genotype 3, and larger hospital size. With universal DAA-access, 72 of 979 HCV-viremic individuals remained DAA-untreated at their last visit. Of these, 39 were no longer in care, 27 remained DAA-untreated in care, and six initiated DAA since database lock. Most common physician-reported barriers to DAA-uptake were patient refusal (20/72, 28%) and infrequent visit attendance (19/72, 26%). Only one DAA-untreated individual in care was engaging in activities associated with onward HCV-transmission.Conclusions: Prevalence of HCV-viremic PWH is low in the Netherlands, coinciding with widespread DAA-uptake. Barriers to DAA-uptake appear mostly patient-related, while HCV-transmission seems unlikely from the few DAA-untreated in care.

Treatment as prevention effect of direct-acting antivirals on primary hepatitis C virus incidence: findings from a multinational cohort between 2010 and 2019

“…However, some countries have reported that HCV treatment uptake has declined since DAAs were first introduced, and those remaining to be treated are less engaged in care, reducing opportunities for HCV care. 33,34 Decreasing the time between infection and treatment and reducing loss to care are key to achieving HCV elimination. For example, in the Swiss TasP trial offering PCR-based screening to all MSM, one in three patients with a new HCV infection lacked HCV antibodies despite testing RNA positive.…”

Hepatitis C Elimination in the Netherlands (CELINE): How nationwide retrieval of lost to follow-up hepatitis C patients contributes to micro-elimination

“…In the Netherlands however, this contribution will be minor. Micro-elimination in other subpopulations in the Netherlands has already been highly successful, such as people living with HIV and people with inherited bleeding disorders [12,13]. Increased efforts to find and cure HCV-viraemic individuals in other subpopulations, like migrants from high-endemic countries, PWID and incarcerated individuals, are needed.…”

“…Results: Retrieval was implemented in 45 sites in the Netherlands. Of 20,183 ever-diagnosed patients, 13,198 (65%) were known to be cured or still in care and 1,537 (8%) were LTFU and eligible for retrieval. Contact was established with 888/1,537 (58%) invited individuals; 369 (24%) had received prior successful treatment elsewhere, 131 (9%) refused re-evaluation and 251 (16%) were referred for re-evaluation.…”

Reinfection incidence and risk among people treated for recent hepatitis C virus infection: the react study

“…In addition, differences in healthcare and harm reduction provision, DAA scale-up and access (including for retreatment) and regional HCV RNA prevalence may have influenced reinfection risk [2,4,[26][27][28][29][30].…”