Impact of Direct-Acting Antivirals on the Burden of HCV Infection Among Persons Who Inject Drugs and Men Who Have Sex With Men in the Swiss HIV Cohort Study

Salazar‐Vizcaya, Luisa; Wandeler, Gilles; Fehr, Jan; Braun, Dominique L; Cavassini, Matthias; Stoeckle, Marcel; Bernasconi, Enos; Hoffmann, Matthias; Rougemont, Mathieu; Béguelin, Charles; Rauch, Andri

doi:10.1093/ofid/ofy154

Cited by 18 publications

(21 citation statements)

References 12 publications

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“…Finally, MSM with acute HCV should be linked to DAA therapies early, with no restrictions on treatment of reinfections, to benefit from the ‘treatment as prevention’ effect . Nonetheless, scaling up of treatment may not be sufficient to achieve HCV elimination in MSM, unless accompanied by behavioural change …”

Section: Discussionmentioning

confidence: 99%

Transmission of hepatitis C virus in HIV‐positive and PrEP‐using MSM in England

Bradshaw

Vasylyeva

Davis

et al. 2020

Journal of Viral Hepatitis

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We sought to characterize risk factors and patterns of HCV transmission amongst men who have sex with men (MSM). MSM with recently acquired HCV (AHCV) were prospectively recruited ('clinic cohort') between January and September 2017. Clinical data and risk behaviours were identified and blood obtained for HCV whole genome sequencing. Phylogenetic analyses were performed, using sequences from this cohort and two other AHCV cohorts, to identify transmission clusters. Sixteen (40.0%) men in the clinic cohort were HIV‐negative MSM. HIV‐negative MSM were younger than HIV‐positive MSM; most (81.3%) had taken HIV PrEP in the preceding year. Eighteen men (45.0%) reported injection drug use; most (34, 85.0%) reported noninjection drug use in the last year. Most in both groups reported condomless anal sex, fisting and sex in a group environment. Few (7, 17.5%) men thought partners may have had HCV. There were 52 sequences in the HCV genotype 1a phylogeny, 18 from the clinic cohort and 34 from other AHCV cohorts; 47 (90.4%) clustered with ≥1 other sequence. There were 7 clusters of 2‐27 sequences; 6 clusters contained HIV‐negative and HIV‐positive MSM and 1 cluster only HIV‐positive MSM. Four of these clusters were part of larger clusters first described in 2007. PrEP‐using MSM are at risk of HCV, sharing similar risk factors to HIV‐positive MSM. Phylogenetics highlights that PrEP‐using and HIV‐positive MSM are involved in the same HCV transmission networks. Few men demonstrated HCV awareness and risk reduction strategies should be expanded.

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Section: Discussionmentioning

confidence: 99%

Transmission of hepatitis C virus in HIV‐positive and PrEP‐using MSM in England

Bradshaw

Vasylyeva

Davis

et al. 2020

Journal of Viral Hepatitis

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“…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%

“…Realworld data demonstrate a reduction in HCV viremia incidence and prevalence with unrestricted access to HCV therapy. (305,319) 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). (303,(320)(321)(322) Additionally, delay introduced by waiting for spontaneous clearance may increase the number of patients lost to follow-up.…”

Section: After the Initial Diagnosis Of Acute Hcv With Viremia (Def Imentioning

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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“…In many countries treatment is now available for all individuals with a chronic HCV infection, irrespective of fibrosis stage . Modelling studies were the first to demonstrate that rapid scale‐up of DAA might limit onward transmission and chronic HCV prevalence and incidence among MSM could decline . However, for substantial reductions a decline in risk behaviour is needed as the scale‐up of DAA is counterbalanced by ongoing risk behaviour, resulting in initial and reinfections .…”

Section: Methodsmentioning

confidence: 99%

“…Modelling studies were the first to demonstrate that rapid scale‐up of DAA might limit onward transmission and chronic HCV prevalence and incidence among MSM could decline . However, for substantial reductions a decline in risk behaviour is needed as the scale‐up of DAA is counterbalanced by ongoing risk behaviour, resulting in initial and reinfections . In addition, early treatment, including treatment of acute infection, might further reduce HCV incidence .…”

Section: Methodsmentioning

confidence: 99%

Sexually transmitted hepatitis C virus infections: current trends, and recent advances in understanding the spread in men who have sex with men

et al. 2019

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Introduction Hepatitis C virus (HCV) is a major public health threat. Although the recent availability of highly effective directly acting antivirals created optimism towards HCV elimination, there is ongoing transmission of HCV in men who have sex with men (MSM). We here report current epidemiological trends and synthesise evidence on behavioural, network, cellular and molecular host factors associated with sexual transmission of HCV, in particular the role of HIV‐1 co‐infection. We discuss prevention opportunities focusing on the potential of HCV treatment. Methods We searched MEDLINE, fact sheets from health professional bodies and conference abstracts using appropriate keywords to identify and select relevant reports. Results and discussion Recent studies strongly suggest that HCV is transmitted via sexual contact in HIV‐positive MSM and more recently in HIV‐negative MSM eligible for or on pre‐exposure prophylaxis. The reinfection risk following clearance is about 10 times the risk of primary infection. International connectedness of MSM transmission networks might contribute to ongoing reinfection. Some of these networks might overlap with networks of people who inject drugs. Although, the precise mechanisms facilitating sexual transmission remain unclear, damage to the mucosal barrier in the rectum could increase susceptibility. Mucosal dendritic cell subsets could increase HCV susceptibility by retaining HCV and transmitting the virus to other cells, allowing egress into blood and liver. Early identification of new HCV infections is important to prevent onward transmission, but early diagnosis of acute HCV infection and prompt treatment is hampered by the slow rate of HCV antibody seroconversion, which in rare cases may take more than a year. Novel tests such as testing for HCV core antigen might facilitate early diagnosis. Conclusions High‐risk sexual behaviour, network characteristics, co‐infection with sexually transmitted infections like HIV‐1 and other concomitant bacterial and viral sexually transmitted infections are important factors that lead to HCV spread. Targeted and combined prevention efforts including effective behavioural interventions and scale‐up of HCV testing and treatment are required to halt HCV transmission in MSM.

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Impact of Direct-Acting Antivirals on the Burden of HCV Infection Among Persons Who Inject Drugs and Men Who Have Sex With Men in the Swiss HIV Cohort Study

Cited by 18 publications

References 12 publications

Transmission of hepatitis C virus in HIV‐positive and PrEP‐using MSM in England

Transmission of hepatitis C virus in HIV‐positive and PrEP‐using MSM in England

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

Sexually transmitted hepatitis C virus infections: current trends, and recent advances in understanding the spread in men who have sex with men

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