Outcomes of an HCV elimination program targeting the Viennese MSM population

Abstract

Summary Background and aims Recent reports suggest an increasing incidence of hepatitis C virus (HCV) infections among MSM (men-who-have-sex-with-men). Early treatment with direct-acting antivirals (DAAs) achieves high cure rates and prevents further HCV transmission. We offered barrier-free HCV screening in the Viennese MSM population and immediate access to DAA treatment. Methods In collaboration with gay health specialists, we screened for HCV seropositivity in Viennese MSM between 2019 and 2020. Barrier-free HCV-RNA-PCR tests, transient elastography (TE) and immediate access to DAA treatment were offered. Results A total of 310 HCV-seropositive patients were identified. Of those, 145 could be contacted and 109 attended their appointment at our clinic. HIV-coinfection was highly prevalent in our cohort (n = 86/145; 78.9%), while pre-exposure prophylaxis (PrEP) was taken by 21.7% (n = 5/23) of non-HIV patients. Sexual risk behavior and (history of) intravenous drug use was reported by 32.1% and 13.8% of patients, respectively. Most MSM had already achieved sustained virological response (SVR) to previous antiviral treatment (n = 72, 66.1%) or experienced spontaneous clearance (n = 10, 9.2%). Advanced fibrosis was only detected in 3/109 (2.8%) patients. 30 MSM tested positive for HCV-RNA and DAA treatment was initiated in 29 patients – all achieved SVR. Conclusion A targeted HCV test-and-treat program revealed a high prevalence of HCV seropositivity among Viennese MSM, potentially associated with high-risk sexual behavior and drug use. Early DAA treatment seems warranted in viremic HCV-MSM as SVR was 100%, which in turn prevents further HCV transmission.

The ‘Viennese epidemic’ of acute HCV in the era of direct‐acting antivirals

“…Our findings will allow to design specific screening and treatments programmes (i.e., micro‐elimination) targeting the high‐risk group of HIV+ and HIV‐negative MSM engaging in high‐risk HCV transmission behaviour. Importantly, a first MSM‐targeted HCV screening programme has already been conducted in Vienna 40 …”

“…Importantly, a first MSM-targeted HCV screening programme has already been conducted in Vienna. 40 However, our study also has limitations: First, the retrospective design is likely prone to bias. As a tertiary care centre, the numbers of incident AHC at our clinic are to some extent dependent on a referral structure that may have changed throughout the years.…”

HCV hotline facilitates Hepatitis C elimination during the COVID‐19 pandemic

“…LSM was conducted after a fasting period of at least 4 hours. For staging of liver fibrosis (F0‐4), the following cutoffs were used: F0/1: <7.1 kPa; F2: ≥7.1 kPa and <9.5 kPa; F3: ≥9.5 kPa and <12.5 kPa; F4: ≥12.5 kPa, as previously described 29,30 …”

Trends in Hepatitis C Virus Seroprevalence and Associated Risk Factors among MSM in Pakistan: Insights from a Community-Based Study

“…For MSM, especially those living with the human immunodeficiency virus (HIV), unprotected sex, notably when combined with chemsex, is recognized as a potential HCV transmission route 14,15 . Studies have consistently shown a higher prevalence of HCV infection in MSM compared to the general population 10,16,17 .…”