Toward microelimination of hepatitis C and HIV coinfection in NHS Tayside, Scotland: Real‐world outcomes

Abstract

Background and aims NHS Tayside is a health board in Scotland which serves around 400 000 residents. Approximately, 2761 are estimated to be persons who inject drugs (PWID), and therefore at risk of infections such as hepatitis C (HCV) and HIV. There are few studies exploring mechanisms and success of eliminating HCV in HIV co‐infected PWID using real‐world data. This study aims to empirically assess HCV treatment outcomes in people living with HIV (PLHIV) to evaluate progress toward microelimination of HCV in the HIV‐positive population in Tayside. Methods HCV testing and treatment details for PLHIV stored on clinical databases dating from 2001 were extracted and anonymized. HCV treatment uptake among co‐infected patients eligible for HCV treatment was calculated. Reinfection incidence was calculated in person years. Confidence intervals were calculated assuming Poisson distribution. Caldicott Guardian approval was obtained to access patient data (ref: IGTCAL 5677). Results Ninety‐six percent of PLHIV were tested for HCV across nine services and aware of their HCV status. From 2001 to 2019, 58 PLHIV were HCV co‐infected. Four left the area and five died prior to HCV treatment. Forty‐nine were eligible for HCV treatment. Thirty were treated with PEGylated interferon (Peg‐IFN); 18 with direct acting antivirals (DAA). One is yet to be treated. Twelve treated with Peg‐IFN did not achieve sustained viral response (SVR12); 10 were retreated, two died prior to re‐treatment. Injecting drug use was the mode of HCV transmission for 39 of 49 patients. Proportion who achieved SVR12 is 75%; 92% if treated with DAAs. Annual proportions of PLHIV treated for HCV increased from 3.57% in the Peg‐IFN era to 66.67% in the DAA era. Reinfection incidence is 0.2 per 100 person years (CI −0.3 to 0.7). Conclusions NHS Tayside has made progress toward microelimination of HCV among PLHIV. The most common mode of HCV transmission in PLHIV in NHS Tayside is injecting drug use. DAAs increased the proportion of co‐infected PLHIV treated for HCV and produced superior SVR12 results compared to Peg‐IFN.

A Global Systematic Review of Hepatitis C Elimination Efforts through Micro-Elimination

“…Further, reducing the incidence of HCV among PLHIV can lead to regional HCV microelimination among PLHIV. 25 This has led the British HIV Association to release a microelimination statement 26 to treat all HIV/HCV coinfected individuals in the United Kingdom by 2021, a target that should be emulated around the world and which can help eliminated HCV in other populations as well, such as PWID. 27 Despite HCV treatment in children being a key population for microelimination, no included studies reported initiatives among children born to HCV-infected mothers or adolescents who are injecting drugs, for example, El-Sayed and Indolfi 28 reflected on this, further elucidating a gap in the literature for other identified key populations for microelimination initiatives.…”

Hepatitis C virus: A critical approach to who really needs treatment

“…DAAs increased the number of treated patients and produced higher SVR12 results compared to pegylated IFN. However, the number of the patients involved was small[ 357 ]. Rather disappointing results came from Austria where despite the fact that HCV testing was successful in the Viennese HIV-positive patients, HCV prevalence was stable in HIV-positive PWIDs and even doubled in HIV-positive MSMs.…”

Hepatitis C reinfection in former and active injecting drug users in Belgium

“…In a recent study in Norway, the prevalence of HCV reinfection was 2.7% (8/297) and the incidence 2.60/100 PY (95% CI 1.12-5.11) [16]. Also, in Scotland, reinfection in people living with HIV (80% PWID) appears to be notably low, with an incidence of 0.2/100 PY [23]. In a recent meta-analysis including studies from the DAA era, the overall HCV reinfection rate was 5.9/100 PY (95% CI 4.1-8.5) among PWID [17].…”