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Acute HCV Rate Down 68% in HIV+ UK MSM Since 2015
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EASL 2020, Digital International Liver Congress, August 27-29, 2020
Mark Mascolini
Diagnoses of acute HCV infection dropped 68% among HIV-positive men who have sex with men (MSM) in England after a peak in 2015, which coincided with wider access to direct-acting antivirals (DAAs) targeting HCV [1]. But reinfection of HIV-positive MSM cured of HCV infection is on the rise. The researchers published these findings earlier in 2020 [2].
Modeling of the HCV epidemic in London MSM with HIV suggested that early access to DAAs could cut incidence (new diagnoses) of HCV in this population. Researchers from Imperial College Healthcare NHS Trust and colleagues at other centers suggested that quickly linking HCV-diagnosed MSM to care could make it possible to eliminate HCV infection in MSM with HIV.
To explore that possibility, the researchers conducted a retrospective cohort study of HIV-positive men seen at 5 HIV clinics in London and Brighton from 2013 through 2018. During that period, each site reported all acute HCV infections, whether a first or repeat infection.
The NHS Trust team counted 378 acute HCV infections in men with HIV during the study period, including 292 first infections (77%) and 86 reinfections (23%). HCV incidence in HIV-positive MSM peaked at 14.57 per 1000 person-years (95% confidence interval [CI] 10.95 to 18.20) in the second half of 2015, then fell to 4.63 per 1000 person-years (95% CI 2.60 to 6.67) in 2018.
The researchers calculated that incidence of first HCV infection in MSM with HIV fell 78% since the 2015 peak, which came at the time of expanding access to DAAs. Overall HCV incidence in this population dropped 68% since the 2015 peak. Time from HCV diagnosis to starting DAAs plunged from 29.8 months in 2013 to 3.7 months in 2018.
But reinfections represented 45% of HCV infections in these men in 2018, compared with a reinfection rate of 26% in 2013 and an overall reinfection rate of 23% for the whole study period.
The researchers believe "further interventions to reduce [HCV] transmission, including earlier access to treatment and for reinfection, are likely needed for micro-elimination to be achieved in this population."
References
1. Garvey L, Cooke G, Smith C, et al. Decline in HCV incidence in HIV positive MSM--progress to HCV micro-elimination in the UK? EASL 2020, Digital International Liver Congress, August 27-29, 2020. Abstract AS039.
2. Garvey LJ, Cooke GS, Smith C, et al. 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? Clin Infect Dis. 2020. ciaa021, https://doi.org/10.1093/cid/ciaa021.
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