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. 2021 Jan 27;72(2):233-238.
doi: 10.1093/cid/ciaa021.

Decline in Hepatitis C Virus (HCV) Incidence in Men Who Have Sex With Men Living With Human Immunodeficiency Virus: Progress to HCV Microelimination in the United Kingdom?

Lucy J Garvey  1 , Graham S Cooke  1   2 , Colette Smith  3 , Christoph Stingone  4 , Indrajit Ghosh  5 , Subathira Dakshina  5 , Lakshmi Jain  5 , Laura J Waters  5 , Tabitha Mahungu  4 , Filippo Ferro  4 , Chandni Sood  1 , Carolyn Freeman  1 , Clare Phillips  6 , Rageshri Dhairyawan  7 , Ruth Burholt  6 , Harriet Sharp  6 , Sadna Ullah  7 , Yvonne Gilleece  6 , Ashley Brown  1 , Chloe Orkin  7   8 , Alison Rodger  3   4 , Sanjay Bhagani  4
Affiliations

Decline in Hepatitis C Virus (HCV) Incidence in Men Who Have Sex With Men Living With Human Immunodeficiency Virus: Progress to HCV Microelimination in the United Kingdom?

Lucy J Garvey et al. Clin Infect Dis. .

Abstract

Background: Modeling of the London hepatitis C virus (HCV) epidemic in men who have sex with men (MSM) and are living with human immunodeficiency virus (HIV) suggested that early access to direct-acting antiviral (DAA) treatment may reduce incidence. With high rates of linkage to care, microelimination of HCV within MSM living with HIV may be realistic ahead of 2030 World Health Organization targets. We examined trends in HCV incidence in the pre- and post-DAA eras for MSM living with HIV in London and Brighton, United Kingdom.

Methods: A retrospective cohort study was conducted at 5 HIV clinics in London and Brighton between 2013 and 2018. Each site reported all acute HCV episodes during the study period. Treatment timing data were collected. Incidence rates and reinfection proportion were calculated.

Results: A total of.

378 acute HCV infections were identified, comprising 292 first infections and 86 reinfections. Incidence rates of acute HCV in MSM living with HIV peaked at 14.57/1000 person-years of follow-up (PYFU; 95% confidence interval [CI], 10.95-18.20) in 2015. Rates fell to 4.63/1000 PYFU (95% CI, 2.60 to 6.67) by 2018. Time from diagnosis to starting treatment declined from 29.8 (2013) to 3.7 months (2018).

Conclusions: We observed a 78% reduction in the incidence of first HCV episode and a 68% reduction in overall HCV incidence since the epidemic peak in 2015, which coincides with wider access to DAAs in England. Further interventions to reduce transmission, including earlier access to treatment and for reinfection, are likely needed for microelimination to be achieved in this population.

Keywords: HIV; directly acting antivirals; hepatitis C; microelimination.

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Figures

Figure 1.
Figure 1.
Incidence of acute hepatitis C virus infections, 2013 and 2018. Abbreviations: HIV, human immunodeficiency virus; MSM, men who have sex with men; PYFU, person-years of follow-up. Abbreviation: Q, quarter.
Figure 2.
Figure 2.
Hepatitis C virus first infections and reinfections in men who have sex with men living with human immunodeficiency virus, 2013–2018. Abbreviations: HIV, human immunodeficiency virus; HCV, hepatitis C virus; MSM, men who have sex with men; Q, quarter.
Figure 3.
Figure 3.
Treatment pathway undertaken according to year of acute HCV diagnosis, 2013–2018. Abbreviations: DAAs, direct-acting antivirals; HCV, hepatitis C virus; NHS, National Health Service; PEG IFN, pegylated interferon. Abbreviation: Q, quarter.
Figure 4.
Figure 4.
Hepatitis C virus (HCV) viremia following acute HCV infection within a cohort of men who have sex with men living with human immunodeficiency virus, 2013–2018. Abbreviations: HIV, human immunodeficiency virus; MSM, men who have sex with men; Q, quarter.
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