The hepatitis C virus epidemics in key populations (including people who inject drugs, prisoners and MSM)

Abstract

Purpose of Review The burden of HCV is high among people who inject drugs (PWID) and prisoners, and increasing among HIV-infected men who have sex with men (MSM), who are key populations for HCV transmission in high-income countries, and may also play a role in many in low and middle-income countries. There is increasing interest in the use of HCV antiviral treatment for prevention in these populations. Recent Findings Numerous theoretical modeling studies have explored the potential impact of HCV treatment for prevention among PWID in a range of global settings, generally finding that modest and achievable levels of HCV treatment, especially with interferon-free direct acting antiviral therapy (IFN-free DAAs), could substantially reduce HCV chronic prevalence among PWID within the next 10–20 years. Additionally, modelling studies have shown HCV testing and treatment in prison (including prevention benefits) could be cost-effective if continuity of care is ensured, or HCV treatments are shortened with DAAs. Modelling work among HIV-infected MSM has shown that further HCV treatment scale-up is likely required despite high treatment rates in this population. However, no empirical studies have explored whether HCV treatment can reduce HCV prevalence and prevent onwards transmission among those at risk of transmission. Summary HCV treatment for key populations such as PWID, prisoners, and MSM could become an important HCV prevention intervention, especially in the IFN-free DAA era. However, there is an urgent need to test these hypotheses through empirical studies.

Dual sexual and drug-related predictors of hepatitis C incidence among sex workers in a Canadian setting: gaps and opportunities for scale-up of hepatitis C virus prevention, treatment, and care

“…HCV is known to disproportionately affect marginalized and underserved populations, primarily people who inject drugs (PWID) 4–6 , and to a lesser extent, men who have sex with men (MSM) 5,7 . Although research on HCV among people who use non-injection drugs has recently increased, little remains known regarding HCV incidence among other key populations, particularly sex workers, who face potentially elevated risks due to dual drug and sexual transmission pathways.…”

Emerging viral STIs among HIV-positive men who have sex with men: the era of hepatitis C virus and human papillomavirus

“…Mathematical modelling studies suggest that scaling up treatment cannot revert the HCV epidemic if high-risk behaviour continues to increase as it has over the last decade. Reducing high-risk behaviour, independent of treatment interventions, would be the most effective intervention for HIV-positive MSM 44 45. In addition, DAA treatment is costly and antiviral resistance might be lurking 46.…”

Transmission of hepatitis C virus infection among younger and older people who inject drugs in Vancouver, Canada

“…Given the complex dynamics of HCV transmission among PWID demonstrated in this study, HCV treatment as prevention strategies that target both young PWID (at greater risk of transmission) and older PWID (at greatest risk of HCV-related liver disease progression) may result in prevention of both new HCV infections and HCV-related advanced liver disease [44, 45]. While the findings from this study could be used to inform dynamics mathematical models of HCV transmission among PWID, further prospective interventional studies are also needed to evaluate optimal HCV treatment as prevention strategies.…”