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. 2020 Apr;40(4):787-796.
doi: 10.1111/liv.14399. Epub 2020 Mar 4.

Epidemiological trends in HCV transmission and prevalence in the Viennese HIV+ population

Caroline Schmidbauer  1   2   3 , David Chromy  1   2   4 , Victor Schmidbauer  5 , David Bauer  1   2 , Michael Apata  1   2 , Dung Nguyen  1   2 , Mattias Mandorfer  1   2 , Benedikt Simbrunner  1   2 , Armin Rieger  4 , Florian Mayer  6 , Ralf Schmidt  6 , Heidemarie Holzmann  7 , Michael Trauner  2 , Michael Gschwantler  3 , Thomas Reiberger  1   2
Affiliations

Epidemiological trends in HCV transmission and prevalence in the Viennese HIV+ population

Caroline Schmidbauer et al. Liver Int. 2020 Apr.

Abstract

Background & aims: Human immunodeficiency virus (HIV)/hepatitis C virus (HCV) coinfection is common in people who inject drugs (PWIDs). Recently, 'high-risk' behaviour among men who have sex with men (MSM) has emerged as another main route of HCV transmission. We analysed temporal trends in HCV epidemiology in a cohort of Viennese HIV+ patients.

Methods: Hepatitis C virus parameters were recorded at HIV diagnosis (baseline [BL]) and last visit (follow-up [FU]) for all HIV+ patients attending our HIV clinic between January 2014 and December 2016. Proportions of HIV+ patients with anti-HCV(+) and HCV viraemia (HCV-RNA(+)) at BL/FU were assessed and stratified by route of transmission.

Results: In all, 1806/1874 (96.4%) HIV+ patients were tested for HCV at BL. Anti-HCV(+) was detected in 93.2% (276/296) of PWIDs and in 3.7% (31/839) of MSM. After a median FU of 6.9 years, 1644 (91.0%) patients underwent FU HCV-testing: 167 (90.3%) of PWIDs and 49 (6.7%) of MSM showed anti-HCV(+). Among 208 viraemic HCV-RNA(+) patients at BL, 30 (14.4%) had spontaneously cleared HCV, 76 (36.5%) achieved treatment-induced eradication and 89 (42.8%) remained HCV-RNA(+) at last FU. Among 1433 initially HCV-naive patients, 45 (3.5%) acquired de-novo HCV infection (11.1% PWIDs/80.0% MSM; incidence rate (IR) 0.004%; 95% confidence interval [CI] 0.0%-0.022%) and 14 had HCV reinfections (85.7% PWIDs/14.3% other; IR 0.001%; 95% CI 0.0%-0.018%) during a median FU of 6.7 years (interquartile range 7.4).

Conclusion: Hepatitis C virus testing was successfully implemented in the Viennese HIV(+) patients. Anti-HCV(+) prevalence remained stable in HIV+ PWIDs but almost doubled in HIV+ MSM. De-novo HCV infection occurred mostly in MSM, while HCV reinfections were mainly observed in PWIDs. HCV treatment uptake was suboptimal with 42.8% remaining HCV-RNA(+) at FU.

Keywords: Hepatitis C virus; MSM; PWIDs; epidemiology; human immunodeficiency virus.

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Conflict of interest statement

Schmidbauer C received travel support from Gilead and Abbvie. Chromy Dreceived payments for consulting from MSD, Abbvie and Gilead as well as travel support from Abbvie and Gilead. Bauer D received travel support from Gilead and Abbvie. Mandorfer M served as a speaker and/or consultant and/or advisory board member for AbbVie, Bristol‐Myers Squibb, Gilead, and W. L. Gore & Associates and received travel support from AbbVie, Bristol‐Myers Squibb, and Gilead. Simbrunner B received travel support from AbbVie and Gilead. Trauner M served as speaker for BMS, Falk Foundation, Gilead and MSD; advisory boards for Albireo, BiomX, Falk Pharma GmbH, Genfit, Gilead, Intercept, MSD, Novartis, Phenex and Regulus. He further received travel grants from Abbvie, Falk, Gilead and Intercept and research grants from Albireo, Cymabay, Falk, Gilead, Intercept, MSD and Takeda. He is also co‐inventor of patents on the medical use of norUDCA. Gschwantler M received grant support from Abbvie, Gilead and MSD; speaking honoraria from Abbvie, Gilead, Intercept, and MSD; consulting/advisory board fees from Abbvie, Gilead, Intercept and MSD; and travel support from Abbvie and Gilead. Reiberger T received grant support from Abbvie, Boehringer‐Ingelheim, Gilead, MSD, Philips Healthcare, Gore; speaking honoraria from Abbvie, Gilead, Gore, Intercept, Roche, MSD; consulting/advisory board fee from Abbvie, Bayer, Boehringer‐Ingelheim, Gilead, Intercept, MSD, Siemens; and travel support from Boehringer‐Ingelheim, Gilead and Roche. Schmidbauer V, Apata M, Nguyen D, Rieger A, Mayer F, Schmidt R and Holzmann H have nothing to disclose.

Figures

Figure 1
Figure 1
Patient flowchart. BL, baseline; FU, follow‐up; HCV, hepatitis C virus; HIV, human immunodeficiency virus; MSM, men who have sex with men; PCR, polymerase chain reaction; PWIDs, people who inject drugs; RNA, ribonucleic acid; SpC, spontaneous clearance; SVR, sustained virological response
Figure 2
Figure 2
HCV testing and prevalence in the HIV cohort by HIV transmission route. A, HIV transmission routes in the overall HIV cohort and in the HCV‐RNA(+) cohort; B, HCV prevalence in HIV+ PWIDs; C, HCV prevalence in HIV+ MSM. BL, baseline; FU, follow‐up; HCV, hepatitis C virus; HIV, human immunodeficiency virus; MSM, men who have sex with men; PWIDs, people who inject drugs; RNA, ribonucleic acid
Figure 3
Figure 3
Follow‐up of the HIV cohort. A, FU of patients with HCV viraemia at BL; B, HCV infections during FU. BL, baseline; FU, follow‐up; HCV, hepatitis C virus; HIV, human immunodeficiency virus; MSM, men who have sex with men; PWIDs, people who inject drugs; RNA, ribonucleic acid; SVR, sustained virological response
Figure 4
Figure 4
Evaluation of biochemical liver damage and advanced fibrosis by ALT‐levels and FIB4‐Score in HIV+ patients with HCV viraemia at baseline. A, Proportion of Patients with elevated ALT at BL and FU; B, Proportion of Patients with elevated FIB4 at BL and FU. ALT, alanine aminotransferase (ULN <35 U/L (f); <50 U/L (m)); BL, baseline; FIB4, fibrosis‐4 Score; FU, follow‐up; HCV, hepatitis C virus; HIV, human immunodeficiency virus; RNA, ribonucleic acid; ULN, upper limit of normal
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