Declining Hepatitis C Virus (HCV) Incidence in Dutch Human Immunodeficiency Virus-Positive Men Who Have Sex With Men After Unrestricted Access to HCV Therapy

Boerekamps, Anne; Berk, Guido E van den; Lauw, Fanny N.; Leyten, Eliane M. S.; Kasteren, Marjo E. van; Eeden, Arne van; Posthouwer, D.; Claassen, Mark A. A.; Dofferhoff, Anton S M; Verhagen, Dominique W M; Bierman, Wouter F W; Lettinga, Kamilla D.; Kroon, F.P.; Delsing, Corine E.; Groeneveld, P. H. P.; Soetekouw, Robert; Peters, Edgar J.G.; Hullegie, Sebastiaan J.; Popping, Stephanie; Vijver, David van de; Boucher, Charles A.; Arends, Joop E.; Rijnders, Bart J. A.

doi:10.1093/cid/cix1007

Cited by 154 publications

(126 citation statements)

References 23 publications

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“…We consider it unlikely that HCV treatment as prevention alone will result in a 90% reduction in the incidence of HCV (the WHO target) among HIV+ MSM in the Netherlands, and discuss additional steps likely required in the following section. Indeed, no further decline in the HCV incidence has been observed in 2017 so far . In addition, we note that the Dutch experience is a specific example within a resource‐rich country with well‐coordinated HIV and HCV care.…”

Section: Resultsmentioning

confidence: 73%

Is hepatitis C virus elimination possible among people living with HIV and what will it take to achieve it?

et al. 2018

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IntroductionThe World Health Organization targets for hepatitis C virus (HCV) elimination include a 90% reduction in new infections by 2030. Our objective is to review the modelling evidence and cost data surrounding feasibility of HCV elimination among people living with HIV (PLWH), and identify likely components for elimination. We also discuss the real‐world experience of HCV direct acting antiviral (DAA) scale‐up and elimination efforts in the Netherlands.MethodsWe review modelling evidence of what intervention scale‐up is required to achieve WHO HCV elimination targets among HIV‐infected (HIV+) people who inject drugs (PWID) and men who have sex with men (MSM), review cost‐effectiveness of HCV therapy among PLWH and discuss economic implications of elimination. We additionally use the real‐world experience of DAA scale‐up in the Netherlands to illustrate the promise and potential challenges of HCV elimination strategies in MSM. Finally, we summarize key components of the HCV elimination response among PWLH.Results and discussionModelling indicates HCV elimination among HIV+ MSM and PWID is potentially achievable but requires combination treatment and either harm reduction or behavioural risk reductions. Preliminary modelling indicates elimination among HIV+ PWID will require elimination efforts among PWID more broadly. Treatment for PLWH and high‐risk populations (PWID and MSM) is cost‐effective in high‐income countries, but costs of DAAs remain a barrier to scale‐up worldwide despite the potential low production price ($50 per 12 week course). In the Netherlands, universal DAA availability led to rapid uptake among HIV+ MSM in 2015/16, and a 50% reduction in acute HCV incidence among HIV+ MSM from 2014 to 2016 was observed. In addition to HCV treatment, elimination among PLWH globally also likely requires regular HCV testing, development of low‐cost accurate HCV diagnostics, reduced costs of DAA therapy, broad treatment access without restrictions, close monitoring for HCV reinfection and retreatment, and harm reduction and/or behavioural interventions.ConclusionsAchieving WHO HCV Elimination targets is potentially achievable among HIV‐infected populations. Among HIV+ PWID, it likely requires HCV treatment scale‐up combined with harm reduction for both HIV+ and HIV‐ populations. Among HIV+ MSM, elimination likely requires both HCV treatment and behaviour risk reduction among the HIV+ MSM population, the latter of which to date has not been observed. Lower HCV diagnostic and treatment costs will be key to ensuring scale‐up of HCV testing and treatment without restriction, enabling elimination.

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Section: Resultsmentioning

confidence: 73%

Is hepatitis C virus elimination possible among people living with HIV and what will it take to achieve it?

et al. 2018

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“…Modeling studies support treatment of acute HCV infection, demonstrating cost‐effectiveness assuming high treatment efficacy with a relatively short treatment duration—requisite conditions that currently exist . Successful HCV treatment as prevention of transmission has been demonstrated in several cohorts of HIV‐positive men who have sex with men (MSM), where unrestricted access to DAA therapy resulted in an approximately 50% decrease in acute HCV infections …”

Section: Acute Hcv Infectionmentioning

confidence: 99%

“…The HCV guidance panel newly recommends initiating DAA therapy upon initial diagnosis of acute HCV infection without awaiting possible spontaneous clearance (i.e., a test and treat strategy). Real‐world data demonstrate a reduction in HCV viremia incidence and prevalence with unrestricted access to HCV therapy . Mathematical modeling studies also suggest that scaling up DAA treatment can reduce HCV incidence and prevalence, especially among populations at highest risk of onward transmission (e.g., MSM and PWID) .…”

Section: Acute Hcv Infectionmentioning

confidence: 99%

Hepatitis C Guidance 2019 Update: American Association for the Study of Liver Diseases–Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection

2020

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“…Ongoing and overlapping transmission of HCV among these groups highlights the need for further investigation of factors that influence transmission of this virus . While it is hypothesized that treatment as prevention strategies using direct‐acting antiviral (DAA) therapies may contribute to HCV elimination , more detailed characterization of the transmission of HCV is needed to guide the implementation of these strategies .…”

Section: Introductionmentioning

confidence: 99%

A latent class approach to identify multi‐risk profiles associated with phylogenetic clustering of recent hepatitis C virus infection in Australia and New Zealand from 2004 to 2015

et al. 2019

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IntroductionOver the last two decades, the incidence of hepatitis C virus (HCV) co‐infection among men who have sex with men (MSM) living with HIV began increasing in post‐industrialized countries. Little is known about transmission of acute or recent HCV, in particular among MSM living with HIV co‐infection, which creates uncertainty about potential for reinfection after HCV treatment. Using phylogenetic methods, clinical, epidemiological and molecular data can be combined to better understand transmission patterns. These insights may help identify strategies to reduce reinfection risk, enhancing effectiveness of HCV treatment as prevention strategies. The aim of this study was to identify multi‐risk profiles and factors associated with phylogenetic pairs and clusters among people with recent HCV infection.MethodsData and specimens from five studies of recent HCV in Australia and New Zealand (2004 to 2015) were used. HCV Core‐E2 sequences were used to infer maximum likelihood trees. Clusters were identified using 90% bootstrap and 5% genetic distance threshold. Multivariate logistic regression and latent class analyses were performed.ResultsAmong 237 participants with Core‐E2 sequences, 47% were in a pair/cluster. Among HIV/HCV co‐infected participants, 60% (74/123) were in a pair/cluster, compared to 30% (34/114) with HCV mono‐infection (p < 0.001). HIV/HCV co‐infection (vs. HCV mono‐infection; adjusted odds ratio (AOR), 2.37, 95% confidence interval (CI), 1.45, 5.15) was independently associated with phylogenetic clustering. Latent class analysis identified three distinct risk profiles: (1) people who inject drugs, (2) HIV‐positive gay and bisexual men (GBM) with low probability of injecting drug use (IDU) and (3) GBM with IDU & sexual risk behaviour. Class 2 (vs. Class 1, AOR 3.40; 95% CI, 1.52, 7.60), was independently associated with phylogenetic clustering. Many clusters displayed homogeneous characteristics, such as containing individuals exclusively from one city, individuals all with HIV/HCV co‐infection or individuals sharing the same route of acquisition of HCV.ConclusionsClusters containing individuals with specific characteristics suggest that HCV transmission occurs through discrete networks, particularly among HIV/HCV co‐infected individuals. The greater proportion of clustering found among HIV/HCV co‐infected participants highlights the need to provide broad direct‐acting antiviral access encouraging rapid uptake in this population and ongoing monitoring of the phylogeny.

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Declining Hepatitis C Virus (HCV) Incidence in Dutch Human Immunodeficiency Virus-Positive Men Who Have Sex With Men After Unrestricted Access to HCV Therapy

Abstract: Unrestricted DAA availability in the Netherlands was followed by a 51% decrease in acute HCV infections among HIV-positive MSM.

Cited by 154 publications

References 23 publications

Is hepatitis C virus elimination possible among people living with HIV and what will it take to achieve it?

Is hepatitis C virus elimination possible among people living with HIV and what will it take to achieve it?

Hepatitis C Guidance 2019 Update: American Association for the Study of Liver Diseases–Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection

A latent class approach to identify multi‐risk profiles associated with phylogenetic clustering of recent hepatitis C virus infection in Australia and New Zealand from 2004 to 2015

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