Sustained Effect on Hepatitis C Elimination Among Men Who Have Sex With Men in the Swiss HIV Cohort Study: A Systematic Re-Screening for Hepatitis C RNA Two Years Following a Nation-Wide Elimination Program

Abstract

Introduction The Swiss HCVree Trial (NCT 02785666) was conducted in 2015-2017 with the goal of implementing a population-based systematic hepatitis C (HCV) micro-elimination program among men who have sex with men (MSM) living with HIV enrolled in the Swiss HIV Cohort Study (SHCS). The trial led to a 91% and 77% decline of HCV prevalence and incidence, respectively. The long-term effect of this HCV micro-elimination program is yet to be explored. Methods All MSM enrolled in the SHCS were screened for HCV RNA using stored plasma samples obtained in 2019, termed “Swiss HCVree Post” screen. The incidence of HCV infection over time was assessed using additional information on HCV testing routinely collected in the SHCS. Characteristics of participants with replicating HCV infection were analyzed. Results The point-prevalence of “Swiss HCVree Post” (N = 4641) was 0.6%, reflecting a decline of 48% compared to the end of the Swiss HCVree Trial where the prevalence was 1.2%. Further, the incidence of HCV among MSM in the SHCS declined from 0.31/100 person-years (py) (95%-confidence interval (CI) = [0.17,0.55]) in 2017 to 0.19/100 py (95%-CI = [0.09,0.39]) in 2019. Conclusion A systematic HCV RNA-based screening among MSM living with HIV conducted two years after the Swiss HCVree Trial revealed a sustained effect and further decline of the prevalence and incidence of replicating HCV infection. This indicates that the Swiss HCVree Trial was successful in curbing the HCV epidemic among MSM living with HIV in Switzerland.

Can treatment, without prevention, eliminate hepatitis C among men who have sex with men?

“…Evaluations of incidence rates of primary HCV infection and HCV reinfection have been performed in a number of other locales, mostly in Europe and Australia, before and after restrictions on prescribing of DAA were similarly lifted, with mixed findings. For primary infection, some locales found little or no decline in rates, similar to the report from Chromy and colleagues in Vienna 9,10 and some locales found greater reductions in rates but measured only in the short term, 11–14 and in Switzerland, a longer‐term reduction was found, over a period of two years 14 . For reinfections, which are a better measure of elimination efforts as they occur among those who are part of sexual networks with high HCV prevalence and participate in behaviours that mediate HCV transmission, most locales found little or no decline in rates, 9,11,14–16 with the exception of a short‐term decline in the Netherlands 13 …”

“…For primary infection, some locales found little or no decline in rates, similar to the report from Chromy and colleagues in Vienna 9,10 and some locales found greater reductions in rates but measured only in the short term, [11][12][13][14] and in Switzerland, a longerterm reduction was found, over a period of two years. 14 For reinfections, which are a better measure of elimination efforts as they occur among those who are part of sexual networks with high HCV prevalence and participate in behaviours that mediate HCV transmission, most locales found little or no decline in rates, 9,11,[14][15][16] with the exception of a short-term decline in the Netherlands. 13 The lack of significant decline in primary infection rates in some…”

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

“…Evidence from cohorts of PLHIV in high-income countries have shown decreases in primary HCV incidence in recent years, particularly after DAA introduction. [14][15][16][17][18][19][20] However, in some countries, primary incidence was declining before DAA introduction, or trends in incidence have only been analysed during the DAA era. Therefore, it is unclear whether observed incidence reductions would have occurred even without DAAs.…”

Cost‐effectiveness of hepatitis C virus test‐and‐treat and risk reduction strategies among men who have sex with men living with HIV in France

“…However, there is reason to believe that our conclusions regarding the efficiency of risk reduction strategies will apply to other high-income settings with similar HCV epidemics among MSM (i.e. decreasing incidence [46][47][48]). Engagement in chemsex and other high-risk sexual practices substantially contributes to HCV transmission among MSM living with HIV in all settings, and a number of modelling studies have shown that micro-elimination cannot be achieved without implementing risk reduction interventions [15,49,50].…”