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. 2023 Mar 22;10(4):ofad153.
doi: 10.1093/ofid/ofad153. eCollection 2023 Apr.

Hepatitis C Virus Micro-elimination Among People With HIV in San Diego: Are We on Track?

Jaskaran S Cheema  1 , William C Mathews  1 , Adriane Wynn  1 , Laura B Bamford  1 , Francesca J Torriani  1 , Lucas A Hill  1 , Amutha V Rajagopal  1 , Jeffrey Yin  1 , Sonia Jain  2 , Richard S Garfein  1 , Edward R Cachay  1 , Natasha K Martin  1   3
Affiliations

Hepatitis C Virus Micro-elimination Among People With HIV in San Diego: Are We on Track?

Jaskaran S Cheema et al. Open Forum Infect Dis. .

Abstract

Background: Rising incidence of hepatitis C virus (HCV) among people with HIV (PWH) in San Diego County (SDC) was reported. In 2018, the University of California San Diego (UCSD) launched a micro-elimination initiative among PWH, and in 2020 SDC launched an initiative to reduce HCV incidence by 80% across 2015-2030. We model the impact of observed treatment scale-up on HCV micro-elimination among PWH in SDC.

Methods: A model of HCV transmission among people who inject drugs (PWID) and men who have sex with men (MSM) was calibrated to SDC. The model was additionally stratified by age, gender, and HIV status. The model was calibrated to HCV viremia prevalence among PWH in 2010, 2018, and 2021 (42.1%, 18.5%, and 8.5%, respectively), and HCV seroprevalence among PWID aged 18-39 years, MSM, and MSM with HIV in 2015. We simulate treatment among PWH, weighted by UCSD Owen Clinic (reaching 26% of HCV-infected PWH) and non-UCSD treatment, calibrated to achieve the observed HCV viremia prevalence. We simulated HCV incidence with observed and further treatment scale-up (+/- risk reductions) among PWH.

Results: Observed treatment scale-up from 2018 to 2021 will reduce HCV incidence among PWH in SDC from a mean of 429 infections/year in 2015 to 159 infections/year in 2030. County-wide scale-up to the maximum treatment rate achieved at UCSD Owen Clinic (in 2021) will reduce incidence by 69%, missing the 80% incidence reduction target by 2030 unless accompanied by behavioral risk reductions.

Conclusions: As SDC progresses toward HCV micro-elimination among PWH, a comprehensive treatment and risk reduction approach is necessary to reach 2030 targets.

Keywords: HCV; HIV; PWH; modeling.

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Conflict of interest statement

Potential conflicts of interest. N.M. has received unrestricted research grants from Gilead and Merck. E.R.C. has received unrestricted research grants from Gilead and Merck. He also participated in an advisory board for Theratechnologies for an unrelated topic.

Figures

Figure 1.
Figure 1.
Model schematic of (A) HCV disease progression and (B) stratification by age, HIV status, and risk. Abbreviations: HCV, hepatitis C virus; MSM, men who have sex with men; PWID, people who inject drugs.
Figure 2.
Figure 2.
Annual number of new HCV infections among PWH in San Diego County. Scenarios shown are (1) counterfactual continuation of pre-2018 treatment rates (29%/year, blue solid line); (2) observed scale-up from 2018 (to 54% at UCSD and 61%/year non-UCSD, green round dotted line); (3) county-wide scale-up to peak treatment achieved by UCSD (71%/year) from 2021 (71%/year, yellow square dotted line); (4) as in Scenario #3 plus halved transmission risk behavior from 2021 onwards (red dashed line). Mean model projections (lines), with shading denoting the 95% uncertainty interval around the observed scenario (Scenario 2). Abbreviations: HCV, hepatitis C virus; PWH, people with HIV; UCSD, University of California San Diego.
Figure 3.
Figure 3.
HCV viremia prevalence among HCV-seropositive PWH in San Diego County. Scenarios shown are (1) counterfactual continuation of pre-2018 treatment rates (29%/year, blue solid line); (2) observed scale-up from 2018 (to 54% at UCSD and 61%/year non-UCSD, green round dotted line); (3) county-wide scale-up to peak treatment achieved by UCSD (71%/year) from 2021 (71%/year, yellow square dotted line); (4) as in Scenario 3 plus halved transmission risk behavior from 2021 onwards (red dashed line). Mean model projections (lines), with shading denoting the 95% uncertainty interval around the observed scenario (Scenario 2). Abbreviations: HCV, hepatitis C virus; PWH, people with HIV; UCSD, University of California San Diego.
Figure 4.
Figure 4.
HCV reinfection rate among previously treated PWH in San Diego County. Mean model projections (lines) and observed data from UCSD Owen Clinic (dots and whiskers), to which the model was not calibrated. Shading denotes the 95% uncertainty interval around the observed scenario (Scenario 2). Scenarios shown are (1) counterfactual continuation of pre-2018 treatment rates (29%/year, blue solid line); (2) observed scale-up from 2018 (to 54% at UCSD and 61%/year non-UCSD, green round dotted line); (3) county-wide scale-up to peak treatment achieved by UCSD (71%/year) from 2021 (71%/year, yellow square dotted line); (4) as in Scenario 3 plus halved transmission risk behavior from 2021 onwards (red dashed line). Abbreviations: PWH, people with HIV; UCSD, University of California San Diego.
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