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A treatment as prevention trial to eliminate HCV
in HIV positive men who have sex with men: The Swiss HCVree Trial - e-health assisted behavioral intervention to reduce risk in HCV re-infection in MSM
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Treatment-as-Prevention With DAAs Cuts HCV Incidence 50% in Swiss MSM With HIV
25th Conference on Retroviruses and Opportunistic Infections (CROI), March 4-7, 2018, Boston
Mark Mascolini
Nine in 10 HIV-positive Swiss men who have sex with men (MSM) with replicating HCV agreed to direct-acting antiviral (DAA) therapy in the Swiss HCVree trial [1]. Researchers estimated that wide screening and treatment reduced incident HCV infections by 49% and chronic HCV infections by 92.5%.
HCV incidence (the new-detection rate) climbed 18-fold in HIV-positive Swiss MSM since 2002, HCVree investigators noted. In HIV-negative Swiss MSM, HCV prevalence is similar to that of the general population at 0.32%. A national Swiss team planned HCVree to test the feasibility of HCV elimination in MSM coinfected with HCV and HIV [2]. The trial has three phases: (A) identifying potential HCV spreaders by screening all MSM enrolled in the Swiss HIV Cohort Study (SHCS), (B) treating HCV spreaders with free grazoprevir/elbasvir with or without ribavirin, and (C) identifying and treating new HCV spreaders by rescreening MSM in SHCS.
Among 3722 HIV-positive MSM in the SHCS screened by HCV PCR from October 2015 to June 2016, 177 (4.8%) tested positive, of which 30 had incident HCV infection and 147 chronic infection. Thus HCV prevalence stood at nearly 5% in this group of MSM with HIV. Among these 177 men, 161 (91%) received DAA therapy, 122 (76%) with grazoprevir/elbasvir and the others with standard regimens recommended in current European or US guidelines. Among 161 treated men, 99.5% attained sustained virologic response 12 weeks after therapy stopped (SVR12), indicating HCV cure.
When health workers rescreened 3722 MSM with HCV PCR from March to November 2017, 28 men (0.8%) tested positive. In other words, HCV prevalence fell from 4.8% before the intervention to 0.8% afterwards in MSM with HIV. Of the 28 positive tests, the investigators rated 16 (57%) as incident and 12 (43%) as chronic. Twenty-two of these 28 men (79%) received DAA therapy, and all achieved SVR12. From phase A to phase C, incident HCV infections fell from 31 to 16 (49%) and chronic infections fell from 147 to 12 (92.5%).
HCVree investigators proposed that "systematic screening followed by prompt DAA treatment can serve as a model to eliminate HCV in HIV/HCV-coinfected MSM." They plan phylogenetic analyses of infecting virus to determine whether men picked up HCV in Switzerland or abroad. They also aim to assess the impact of a behavioral intervention on sexual risk in MSM with HIV/HCV.
In contrast, a nationwide study of HIV-positive people in France (reported separately by NATAP) found rising HCV incidence among MSM from 2012 through 2016, despite wide uptake of DAA therapy [3].
References
1. Braun DL, Hampel BH, Nguyen H, et al. A treatment as prevention trial to eliminate HCV in HIV+ MSM: the Swiss HCVree Trial. 25th Conference on Retroviruses and Opportunistic Infections (CROI). March 4-7, 2018. Boston. Abstract 81LB.
2. ClinicalTrials.gov. Swiss HCVree Trial (HCVree). https://clinicaltrials.gov/ct2/show/NCT02785666
3. Cotte L, Huleux T, Raffi F, et al. HCV incidence is still increasing in French HIV-infected MSM. 25th Conference on Retroviruses and Opportunistic Infections (CROI). March 4-7, 2018. Boston. Abstract 591.
WEBCAST: http://www.croiwebcasts.org/console/player/37180?mediaType=slideVideo&&crd_fl=1&ssmsrq=1521123534057&ctms=5000&csmsrq=736
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