Microelimination of Hepatitis C Among People With Human Immunodeficiency Virus Coinfection: Declining Incidence and Prevalence Accompanying a Multicenter Treatment Scale-up Trial

Abstract

Background Gay and bisexual men (GBM) are a key population affected by HIV and hepatitis C (HCV) co-infection. Providing HCV treatment scale-up across specialist and non-hepatitis specialist settings may eliminate HCV in this population. We aimed to (1) deliver and measure HCV treatment effectiveness, and (2) determine the population impact of treatment on HCV prevalence and incidence longitudinally. Methods The co-EC Study (Enhancing care and treatment among HCV/HIV co-infected individuals to Eliminate Hepatitis C transmission) was an implementation trial providing HCV direct-acting antiviral treatment in Melbourne, Australia, from 2016-2018. Individuals with HCV/HIV co-infection were prospectively enrolled from primary and tertiary-care services providing care for 85% of GBM with HIV in our jurisdiction. HCV-viraemic prevalence and HCV-antibody/viraemic incidence were measured using a state-wide, individually-linked, electronic surveillance system. Results Among 200 participants recruited, 186 initiated treatment during the study period. Sustained virological response among primary care participants (98%, 95%CI:93-100%) was not different to tertiary care (98%, 95%CI:86-100%). From 2012-2019, between 2434 and 3476 GBM with HIV-infection attended our primary-care sites annually providing 13,801 person-years of follow-up; 50-60% received an HCV test annually, 10-14% were anti-HCV positive. Among those anti-HCV positive, viraemic prevalence declined 83% during the study (54% to 9%; 2016 to 2019). HCV incidence decreased 25% annually from 1.7/100 person-years in 2012 to 0.5/100 person-years in 2019 (incidence rate ratio 0.75; CI:0.68-0.83;p<0.001). Conclusion High treatment effectiveness by non-specialists demonstrates the feasibility of treatment scale-up in this population. Substantial declines in HCV incidence and prevalence among GBM with HIV-infection provides proof-of-concept for HCV micro-elimination. Registration ClinicalTrials.gov (Identifier: NCT02786758).

Brief Report: Low Incidence of Hepatitis C Among a Cohort of HIV-Negative Gay and Bisexual Men Using HIV Pre-exposure Prophylaxis (PrEP) in Melbourne, Australia, and the Contribution of Sexual Transmission

“…22 This resulted in microelimination of HCV among MSM, particularly in Victoria, where DAA treatment was targeted toward HIV–HCV co-infected individuals. 23 Such microelimination is particularly relevant if HIV-negative men on PrEP and HIV-positive men are involved in the same HCV transmission networks, as indicated by phylogenetic analyses from the United Kingdom, France, and Amsterdam. 17,24,25…”

“…22 This resulted in microelimination of HCV among MSM, particularly in Victoria, where DAA treatment was targeted toward HIV-HCV co-infected individuals. 23 Such microelimination is particularly relevant if HIV-negative men on PrEP and HIV-positive men are involved in the same HCV transmission networks, as indicated by phylogenetic analyses from the United Kingdom, France, and Amsterdam. 17,24,25 Of our 5 cases classified as sexually transmitted HCV, all reported receptive condomless anal intercourse with casual sexual partners and participation in group sex and all who were interviewed reported attending a SOPV around the time of their HCV acquisition.…”

Real-world monitoring progress towards the elimination of hepatitis C virus in Australia using sentinel surveillance of primary care clinics; an ecological study of hepatitis C virus antibody tests from 2009 to 2019

“…The National Testing Policy further encourages reflex HCV RNA testing, therefore increases in HCV antibody testing are likely to result in increased diagnosis where reflex testing is undertaken [ 6 ]. Despite the benefits of people accessing HCV care in Australian primary settings, [ 14 , 15 ] HCV treatment by primary care providers has not increased, [ 16 ] and significant gaps remain in linking those diagnosed in primary care to timely treatment initiation [ 17 ]. While we did not monitor trends in HCV treatment in these clinics, our analysis suggests there are ongoing and significant opportunities for HCV diagnoses, and therefore treatment in primary care clinics, especially to individuals accessing OAT.…”

Assessment of the cost-effectiveness of Australia's risk-sharing agreement for direct-acting antiviral treatments for hepatitis C: a modelling study

“…The model also only considered transmission among PWID, and not transmission among other groups such as HIV-positive men who have sex with men and mother-to-child transmission, however this is believed to be considerably lower in Australia due to high engagement in care and treatment uptake in these groups. 50 …”