Microelimination or Not? The Changing Epidemiology of Human Immunodeficiency Virus-Hepatitis C Virus Coinfection in France 2012–2018

Abstract

Background The arrival of highly effective, well tolerated direct-acting antiviral agents (DAA) led to a dramatic decrease in HCV prevalence. HIV-HCV coinfected patients are deemed a priority population for HCV elimination, while a rise of recently acquired HCV infections in MSM has been described. We describe the variations in HIV-HCV epidemiology in the French Dat’AIDS cohort. Methods Retrospective analysis of a prospective HIV-infected cohort from 2012 to 2018. Determination of HCV prevalence, incidence, proportion of viremic patients, treatment uptake and mortality rate in the full cohort and by HIV risk factors. Results From 2012 to 2018, 50861 HIV-infected patients with a known HCV status were followed-up. During the period, HCV prevalence decreased from 15.4% to 13.5%. HCV prevalence among new HIV cases increased from 1.9% to 3.5% in MSM but remained stable in other groups. Recently acquired HCV incidence increased from 0.36/100PY to 1.25/100PY in MSM. The proportion of viremic patients decreased from 67.0% to 8.9%. MSM became the first group of viremic patients in 2018 (37.9%). Recently acquired hepatitis represented 59.2% of viremic MSM in 2018. DAA treatment uptake increased from 11.4% to 61.5%. More treatments were initiated in MSM in 2018 (41.2%) than in IVDU (35.6%). In MSM, treatment at acute phase represented 30.0% of treatments in 2018. Conclusions A major shift in HCV epidemiology was observed in HIV-infected patients in France from 2012 to 2018, leading to a unique situation in which the major group of HCV transmission in 2018 was MSM.

Immediate treatment for recent hepatitis C infection in people with high-risk behaviors: a systematic review and meta-analysis

“…Three studies reported HCV incidence, assessing treatment in MSM with HIV. 17 , 18 , 23 Two of these studies reported a decrease in HCV incidence at the end of the study period; a study nested in a Swiss cohort study, which reported a decrease in incidence from 0.53/100 person years in 2014 to 0.12/100 person years in 2019 23 and a study set in the UK, which reported a decrease from 11.28/1000 person years in 2016 to 4.63/1000 person years in 2018. 18 In contrast, a study nested in a French cohort study found an increase in incidence from 0.73/100 person years in 2015 to 1.25/100 person years in 2018.…”

“… 18 In contrast, a study nested in a French cohort study found an increase in incidence from 0.73/100 person years in 2015 to 1.25/100 person years in 2018. 17 In all the 3 studies, a minority of participants in each cohort (0.5–0.7%) were treated in the acute HCV infection phase.…”

HIV infection and risk of heart failure: A meta-analysis and systematic review

“…In high-income countries and developing countries, 55.12% of the deaths from HIV infections are related to non-HIV infections, especially cardiovascular diseases (37.10%), respectively (Cilliers et al, 2019). Studies (Kanwugu & Adadi, 2021;Cotte et al, 2021) have shown that 80% of cardiovascular diseases occur in low-and middle-income countries, and the risk of cardiovascular diseases for people with HIV infection is approximately 2.13 times that of the general population. Heart failure (HF) is a complex clinical syndrome that can lead to increased patient mortality and readmission (Czuczman et al, 2021).…”