The hepatitis C cascade of care in HIV/hepatitis C virus coinfected individuals in Europe: regional and intra-regional differences

Abstract

on behalf of the EuroSIDA study M Background: Following the introduction of direct-acting antiviral therapy in 2013, WHO launched the first Global Health Sector Strategy on Viral Hepatitis. We describe a hepatitis C virus (HCV) cascade of care in people with HIV (PWH) across Europe in terms of reaching the WHO elimination targets of diagnosing 90% and treating 80% of HCV-infected individuals.Methods: HIV/HCV-coinfected participants in the EuroSIDA cohort under prospective follow-up at October 1, 2019, were described using a nine-stage cascade of care. Care cascades were constructed across Europe, on a regional (n ¼ 5) and country (n ¼ 21) level.Results: Of 4773 anti-HCV positive PWH, 4446 [93.1%, 95% confidence interval (CI) 92.4-93.9)] were ever tested for HCV RNA, and 19.0% (95% CI 16.4-21.6) were currently HCV RNA positive, with the highest prevalence in Eastern and Central-Eastern Europe (33.7 and 29.6%, respectively). In Eastern Europe, 78.1% of the estimated number of chronic infections have been diagnosed, whereas this proportion was above 95% in the other four regions. Overall, 3116 persons have ever started treatment (72.5% of the ever chronically infected, 95% CI 70.9-74.0) and 2404 individuals (55.9% of the ever chronically infected, 95% CI 53.9-57.9) were cured. Cure proportion ranged from 11.2% in Belarus to 87.2% in Austria.

Mortality in hepatitis C virus-cured vs. hepatitis C virus-uninfected people with HIV

“…This, combined with a median follow-up of 3.7 and 3.3 years for G1 and G2, respectively, permitted the observation of a sufficient number of events in both groups. Moreover, our population is comparable to other major European and American cohorts and population-based studies: [27,28] The EUROSIDA study reported 74% of males, a median age of 56 years, 27.8% of prior AIDS diagnosis, and 8% of cirrhosis in 1178 participants with HIV/HCV from Western European countries [27]. Similarly, a U.S.-based study including 1346 Medicare beneficiaries with HIV/HCV and who were DAA treated had 87.5% men, a median age of 56 years, and 7.3% participants with cirrhosis [28].…”

Efficacy of a comprehensive strategy for the detection and treatment of hepatitis C infection in a population attending addiction centers

“…These strategies are known as microelimination strategies ( 3 ). Various actions have been carried out with the objective of achieving the microelimination of hepatitis C in some of these vulnerable populations, such as people living with HIV (PLWH) ( 4 ), individuals admitted to prisons ( 5 ) or people who are currently injected or have a history of injecting drugs (PWID) ( 6 ). Strategies aimed at individuals coinfected with HIV/HCV have been very effective because most of these patients are under active health control and monitoring ( 7 ).…”

Incidence of hepatitis C virus infection among people living with HIV: An Egyptian cohort study

“…1 In the EuroSIDA cohort study, 23 309 PLHIV were enrolled from the WHO European region and Argentina, showing that 57.4% of patients with HIV/HCV co-infection were PWID. 23 The effect of HCV infection on CD4 cell count is controversial. Some studies found a decrease in CD4 cell count with HIV/ HCV co-infection, hypothesised to be due to the apoptosis of CD4 cells caused by HCV.…”

“… 1 In the EuroSIDA cohort study, 23 309 PLHIV were enrolled from the WHO European region and Argentina, showing that 57.4% of patients with HIV/HCV co-infection were PWID. 23 …”