The Incidence of Hepatitis C Among Gay, Bisexual, and Other Men Who Have Sex With Men in Australia, 2009–2019

Abstract

Background Hepatitis C virus (HCV) infection has been reported among gay, bisexual, and other men who have sex with men (GBM) globally including GBM with human immunodeficiency virus (HIV) and HIV-negative GBM, particularly those using HIV preexposure prophylaxis (PrEP). In Australia, HCV direct-acting antiviral treatment (DAA) was government-funded from 2016. Large implementation studies of PrEP also began in 2016. We examined HCV incidence among GBM to assess whether HCV incidence has changed since 2015. Methods Data were drawn from the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance. We included GBM who tested HCV antibody negative at their first test and had ≥1 subsequent test. Generalized linear modeling (Poisson distribution) was used to examine HCV incidence from 2009 to 2019 stratified by HIV status, and among HIV-negative GBM prescribed PrEP from 2016 to 2019. Results Among 6744 GBM with HIV, HCV incidence was 1.03 per 100 person-years (PY). Incidence declined by 78% in 2019 compared to 2015 (incidence rate ratio [IRR], 0.22 [95% confidence interval {CI}: .09–.55]). Among 20 590 HIV-negative GBM, HCV incidence was 0.20/100 PY, with no significant change over time. Among 11 661 HIV-negative GBM prescribed PrEP, HCV incidence was 0.29/100 PY. Compared to 2016, incidence among GBM prescribed PrEP declined by 80% in 2019 (IRR, 0.20 [95% CI: .06–.64]). Conclusions HCV incidence among GBM living with HIV declined following DAA availability. There was no observed change in HCV incidence among HIV-negative GBM overall. Among GBM prescribed PrEP, incidence declined since the early years of PrEP implementation in Australia. Australia is on track to eliminate HCV among GBM before global 2030 targets.

The ‘Viennese epidemic’ of acute HCV in the era of direct‐acting antivirals

“…However, broad DAA access has a strong potential to eliminate HCV in certain populations: Recent surveillance data from Australia indicate a decline of 78% in HCV incidence in 2019 as compared to 2015 8 8 27 .…”

“…However, broad DAA access has a strong potential to eliminate HCV in certain populations: Recent surveillance data from Australia indicate a decline of 78% in HCV incidence in 2019 as compared to 2015. 8 This analysis included more than twenty‐thousand gay and bisexual men and attributed the observed decrease in HCV infections primarily to increased DAA availability. 8 Data of the Swiss HIV Cohort Study also reported a significant decline in HCV incidence in 2019 among MSM following a systematic screening and treatment programme executed from 2015 to 2017.…”

“…AHC, acute HCV infection; HCV, hepatitis C virus; MSM, men who have sex with men; PWID, people who inject drugs 2015. 8 This analysis included more than twenty-thousand gay and bisexual men and attributed the observed decrease in HCV infections primarily to increased DAA availability. 8 Data of the Swiss HIV Cohort Study also reported a significant decline in HCV incidence in 2019 among MSM following a systematic screening and treatment programme executed from 2015 to 2017.…”

“…5,6 Nevertheless, other cohorts reported already of a decline in HCV incidence since DAAs were established. 7,8 For MSM-the affected key population-high-risk sexual behaviour, HIV status, presence of sexually transmitted infections (STI) and sexualized drug use ('chemsex') are well-described risk factors for the acquisition of HCV. [9][10][11] Additionally, several case series have reported a rising number of AHC infections among HIVnegative MSM using pre-exposure prophylaxis for HIV (PrEP).…”

“… 5 , 6 Nevertheless, other cohorts reported already of a decline in HCV incidence since DAAs were established. 7 , 8 …”