Moving Towards Hepatitis C Microelimination Among People Living With Human Immunodeficiency Virus in Australia: The CEASE Study

Abstract

Background Microelimination of hepatitis C virus (HCV) among people living with human immunodeficiency virus (HIV) may be feasible in Australia, given unrestricted access to direct-acting antiviral (DAA) therapy from 2016. Our aim was to evaluate progress towards elimination goals within HIV/HCV-coinfected adults in Australia following universal DAA access. Methods The CEASE prospective cohort study enrolled adults with HIV/HCV, irrespective of viremic status, from 14 primary and tertiary clinics in Australia. Annual and cumulative HCV treatment uptake, outcome, and HCV RNA prevalence were evaluated, with follow-up through May 2018 (median follow-up, 2.63 years). Factors associated with DAA uptake were analyzed. Results Between July 2014 and March 2017, 402 participants who were HIV/HCV antibody positive were enrolled (95% male [80% gay and bisexual men,], 13% cirrhosis, 80% history of injecting drug use [39% currently injecting]). Following universal DAA access, annual HCV treatment uptake in those eligible increased from 7% and 11% per year in 2014 and 2015, respectively, to 80% in 2016. By 2018, cumulative HCV treatment uptake in those ever eligible for treatment was 91% (336/371). HCV viremic prevalence declined from 82% (95% CI, 78–86%) in 2014 to 8% (95% CI, 6–12%) in 2018. Reinfection was reported in only 5 participants for a reinfection incidence of 0.81 per 100 person-years (95% CI, 0.34–1.94). Conclusions High uptake and effectiveness of unrestricted DAA therapy in Australia have permitted rapid treatment scale-up, with a dramatic reduction in HCV infection burden and low reinfection rate among people living with HIV, suggesting that microelimination is feasible. Clinical Trials Registration NCT02102451.

HCV reinfection rates after cure or spontaneous clearance among HIV‐infected and uninfected men who have sex with men

“…It must be noted, however, that the reinfection rate of 3.13/100 PYs observed among MSM with HIV coinfection in our study is lower than the 7.3/100 PYs reported in Western Europe by the NEAT study 2 and the 5.9/100 PYs reported in Spain, 19 but similar to those reported from the United States; a rate of 4.4/100 PYs reported in New York City 20 and 2.9/100 PYs in San Diego 12 . Rate as low as 0.18/100 PYs have also been recently reported by the CEASE study in Australia 14 . While methodological differences may account for these differences, it should be noted that the prevalence of HCV among MSM in Canada is lower than in European cohorts.…”

“…A deeper understanding of reinfection is vital to identify factors that may be protective against or are risk factors for reinfection 11 . However, there exists little real‐world population level data on HCV reinfection following SC or treatment‐based SVR among MSM, especially stratified by HIV status, as the majority of studies have tended to focus exclusively on MSM who are living with HCV/HIV coinfection 2,12‐14 . This is one of the largest population‐based studies to report reinfection rates among MSM using a representative cohort in a real‐world setting.…”

Hepatitis C virus therapy in children: No one should be left behind

“…The SVR 12 was 97% (33/34) and the only patient who did not achieve this virological milestone was a 3-year-old child who discontinued treatment after 5 days of dosing because of "abnormal drug taste". 21 Looking at the details of the two above-described studies it should be noted that swallowing difficulties could apparently impact the compliance with the treatment in such young children. 20,21 As a fact, in the study by Kamal and collaborators a 3-year-old child vomited after the first dose of the drug.…”

“…21 Looking at the details of the two above-described studies it should be noted that swallowing difficulties could apparently impact the compliance with the treatment in such young children. 20,21 As a fact, in the study by Kamal and collaborators a 3-year-old child vomited after the first dose of the drug. 20 The authors advised to grind the tablets in juice in the case of difficulty in swallowing and the patient apparently managed to complete treatment, although this solution, albeit effective in this small pilot study, could affect the absorption of the drugs and potentially impact the effectiveness of treatment in the real life.…”

“…Voluntary licensing, an agreement between an originator manufacturer and a generic manufacturer that allows the production and sale of a patented drug in certain countries, subject to licensing terms, has been increasingly used to expand access to patented key drugs for HCV infection in adults. 21,26 Voluntary licensing of DAAs has been demonstrated to substantially improve HCV treatment uptake in eligible countries for adults and, in the future, will be more and more relevant for children. Generic drug makers are not required to repeat the clinical trials of new drugs but whenever a new paediatric drug formulation is developed it is important that it undergoes rigorous testing.…”