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New HCV Diagnoses Down by Two Thirds in HIV+ Swiss MSM 2010-2020
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18th European AIDS Conference, EACS 2021, October 27-30, 2021, London
Mark Mascolini
Among HIV-positive men who have sex with men (MSM) in the Swiss HIV Cohort Study (SHCS), incidence (new diagnoses) of HCV infection plunged from 0.54 to 0.16 per 100 person-years from 2010 to 2020 [1]. SHCS researchers attribute the success partly to the Swiss HCVree Trial [2].
The World Health Organization set two main goals for global elimination of HCV infection-a 90% reduction in new HCV infections and a 65% reduction in HCV mortality, both by 2030. A key strategy toward achieving these goals is microelimination of HCV infection in high-risk groups.
In deciding which Swiss population to target for microelimination, the SHCS team noted that HCV prevalence has not risen in HIV-negative Swiss MSM and that HCV incidence dropped sharply among intravenous drug users in Switzerland from 2002 to 2011. But health authorities charted an 18-fold jump in HCV incidence among HIV-positive MSM from 2002 through 2011 [3].
Microelimination of HCV in Swiss MSM has two major components, the Swiss HIV Cohort Study (SHCS) and the Swiss HCVree Trial. The SHCS includes an estimated 75% of HIV-infected MSM in Switzerland, for whom data are recorded every 3 to 6 months. MSM in the SHCS get screened for HCV antibodies every 12 months. The Swiss HCVree trial has three phases [2]: (1) from 10/2015 to 6/2016, HCV PCR screening offered to all MSM in the SHCS; (2) from 7/2016 to 2/2017, direct-acting antiviral (DAA) treatment and behavioral intervention to promote risk reduction; (3) from 3/2017 to 11/2017, rescreening to reassess HCV prevalence after the initial intervention.
The Swiss HCVree trial proved successful. Incident HCV infection declined by 57% and prevalent HCV infection plummeted by 84%, from 4.8% before the intervention to 0.8% afterwards. The researchers cited evidence suggesting that the Swiss HCVree Trial may be having a sustained effect by tracking four outcomes from 10/2015-6/2016 to 1/2019-12/2019: (1) all replicating HCV infections fell from 177 to 28; primary (first-time) incident infections dropped from 24 to 9 (found in 2019); reinfections slipped from 6 to 2 (found in 2019); and prevalent infections dropped from 147 to 17. 5 of the 9 primary infections were newly registered in the program so its likely they contracted both HIV and HCV in the same year, the author stated; so new infections among MSM still occur. Regarding prevalent infections they had some participants enrolled in the SHCS for decades with several positive screening results (see graphs below) before and hepatitis treatments but still were positive in 2019 indicating some patients are difficult to treat and need more efforts to eradicate HCV in these patients, the author added.
The SHCS team estimated long-term HCV incidence in 5352 MSM through 40,483 person-years of follow-up from 2010 through 2020 by using the midpoint of the last negative HCV test result and first positive HCV test result. That calculation indicated that HCV incidence in HIV-positive MSM fell from 0.54 per 100 person-years in 2010 to 0.16 per 100 person-years in 2020.
Swiss researchers listed four strategies that might further improve microelimination of HCV in Swiss MSM: (1) Include HIV-negative MSM with high-risk behavior in HCV screening programs. (2) Collaborate internationally to understand country-to-country HCV transmission links. (3) Reengage MSM lost to follow-up in HCV screening programs. (4) Concentrate on difficult-to-treat patients to prevent transmission.
References
1. Kusejko K. Stöckle M, Beguelin C, et al. A systematic re-screening for hepatitis C RNA among men who have sex with men living with HIV in the Swiss HIV Cohort Study two years following a nation-wide elimination program reveals a sustainable effect towards hepatitis C elimination. 18th European AIDS Conference, EACS 2021, October 27-30, 2021, London. Abstract OS2/3.
2. Braun DL, Hampel B, Ledergerber B, et al. A treatment-as-prevention trial to eliminate hepatitis C among men who have sex with men living with human immunodeficiency virus (HIV) in the Swiss HIV Cohort Study. Clin Infect Dis. 2021;73:e2194-e2202. doi: 10.1093/cid/ciaa1124.
3. Wandeler G, Gsponer T, Bregenzer A, et al. Hepatitis C virus infections in the Swiss HIV Cohort Study: a rapidly evolving epidemic. Clin Infect Dis. 2012;55:1408-1416. doi: 10.1093/cid/cis694.
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