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Acute HCV Drops Sharply in HIV-Positive Dutch MSM After DAA Rollout
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Conference on Retroviruses and Opportunistic Infections (CROI), February 13-16, 2017, Seattle
CROI: Unrestricted Dutch Athena Cohort (HIV+/MSM/IDU) DAA Access Leads to Speedy Uptake, High Cure Rates ....'51% decrease in acute HCV, increased STD rates/syphillis' - Mark Mascolini - (03/02/17)
CROI: Summary from CROI 2017 for viral Hepatitis HCV - elimination on its way: dream or emerging reality? - Jurgen K. Rockstroh M.D., Professor of Medicine University of Bonn, Germany Correspondence: Prof. Dr. J.K. Rockstroh Department of Medicine I University of Bonn Sigmund-Freud-Str. 25 53105 Bonn Germany
Mark Mascolini
Acute HCV infections among HIV-positive men who have sex with men (MSM) in the Netherlands fell by half from 2014 through 2016 after direct-acting antivirals (DAAs) became widely accessible [1]. Researchers who reported the finding say it does not prove that DAA uptake directly led to the acute HCV drop, but HCV was the only sexually transmitted infection (STI) that fell in the Netherlands in 2016.
Acute HCV incidence has been rising among HIV-positive MSM across Western Europe [2], Australia, and the United States [3]. In the Netherlands, HCV incidence in HIV-positive MSM stood around 1.1% yearly in 2014. The Netherlands authorized DAA use for advanced HCV infection in September 2014. In November 2015 the country authorized unrestricted reimbursement for DAA use in chronic HCV infection. HIV-positive MSM with HCV avidly sought DAA therapy [4], and cure rates have been high.
The Dutch Acute HCV in HIV Study Group (DAHHS) is investigating new HCV therapies for acute HCV in 8 HIV centers across the country. The first two trials, launched in 2014 and 2016, included about 50% and 65% of people acutely infected with HCV in the Netherlands in those years. In the context of these two trials, researchers tracked incidence of acute HCV in participating centers. The analysis relied on the HCV RNA assay to create a strict definition of acute HCV. The researchers calculated HCV incidence for 2014 and 2016 as the number of acute HCV infections diagnosed divided by person-years of follow-up for HIV-positive MSM in care in 2014.
The DAHHS team counted 93 cases of acute HCV per 8290 person-years of follow-up in 2014 to yield an incidence of 11.2 per 1000 person-years (1.1% per year). In 2016 there were 49 cases of acute HCV per 8961 person-years to yield an incidence of 5.5 per 1000 person-years (0.55% per year). The two rates translated into a 2016/2014 incidence rate ratio of 0.49 (95% confidence interval 0.34 to 0.69), meaning acute HCV incidence fell by half. Incidence appeared to fall even within 2016, with a rate of 6.9 per 1000 person-years in January-June and a rate of 4.0 per 1000 person-years in July-December.
Incidence of other STIs did not dwindle among Netherlands MSM in the same period. Syphilis incidence, for example, increased 41% from 446 new cases in the first half of 2015 to 629 new cases in the first half of 2016. This difference between incidence of other STIs and HCV suggests that some unique force (wide DAA uptake by MSM??) could largely account for falling incidence of acute HCV.
The researchers stress that acute HCV remains far from being eliminated--in the Netherlands or elsewhere. They believe "DAAs as the only intervention will not suffice to eliminate HCV."
References
1. Boerekamps A, van den Berk G, Lauw F, et al. Substantial decline in acute HCV infections among Dutch HIV+MSM after DAA roll out. Conference on Retroviruses and Opportunistic Infections (CROI), February 13-16, 2017, Seattle. Abstract 137LB.
2. van de Laar TJ, Matthews GV, Prins M, Danta M. Acute hepatitis C in HIV-infected men who have sex with men: an emerging sexually transmitted infection. AIDS. 2010;24:1799-1812.
3. Chaillon A, Anderson CM, Martin TC, et al. Incidence of hepatitis C among HIV-infected men who have sex with men, 2000-2015. Conference on Retroviruses and Opportunistic Infections (CROI), February 13-16, 2017, Seattle. Abstract 134.
4. Boerekamps A, Newsum A, Smit C, et al. Unrestricted DAA access in the Netherlands: rapid therapy uptake in HIV+HCV+ patients. Conference on Retroviruses and Opportunistic Infections (CROI), February 13-16, 2017, Seattle. Abstract 136.
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