What is needed to achieve HCV microelimination among HIV-infected populations in Andalusia, Spain: a modeling analysis

• Published in: BMC infectious diseases Vol. 20; no. 1; pp. 588 - 14
• Main Authors: Skaathun, Britt, Borquez, Annick, Rivero-Juarez, Antonio, Mehta, Sanjay R, Tellez, Francisco, Castaño-Carracedo, Manuel, Merino, Dolores, Palacios, Rosario, Macías, Juan, Rivero, Antonio, Martin, Natasha K
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 08.08.2020; BioMed Central; BMC
• Subjects: Analysis; Antiviral agents; Antiviral Agents - therapeutic use; Care and treatment; Cohort Studies; Coinfection - epidemiology; Coinfection - pathology; Comorbidity; Direct-acting antivirals; Disease transmission; Drug abuse; Drug use; Dynamic models; Health aspects; Hepatitis; Hepatitis C; Hepatitis C - diagnosis; Hepatitis C - drug therapy; Hepatitis C - epidemiology; Hepatitis C virus; HIV; HIV infections; HIV Infections - pathology; HIV patients; Homosexuality, Male; Human immunodeficiency virus; Humans; Infections; Infectious diseases; Male; Microelimination; Modelling; Models, Theoretical; Population; Prevalence; Prevention; Prospective Studies; Reduction; Sexually transmitted diseases; Spain - epidemiology; STD; Studies; Substance-Related Disorders - pathology; Sustained Virologic Response; Viruses; Spain; France; Prevention; Microelimination; HIV; Hepatitis C virus; Direct-acting antivirals
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-020-05285-z

Scale-up of hepatitis C virus (HCV) treatment for HIV/HCV coinfected individuals is occurring in Spain, the vast majority (> 85%) with a reported history of injecting drug use and a smaller population of co-infected men who have sex with men (MSM). We assess impact of recent treatment scale-up to people living with HIV (PLWH) and implications for achieving the WHO HCV incidence elimination target (80% reduction 2015-2030) among PLWH and overall in Andalusia, Spain, using dynamic modeling. A dynamic transmission model of HCV/HIV coinfection was developed. The model was stratified by people who inject drugs (PWID) and MSM. The PWID component included dynamic HCV transmission from the HCV-monoinfected population. The model was calibrated to Andalusia based on published data and the HERACLES cohort (prospective cohort of HIV/HCV coinfected individuals representing > 99% coinfected individuals in care in Andalusia). From HERACLES, we incorporated HCV treatment among diagnosed PLWH of 10.5%/year from 2004 to 2014, and DAAs at 33%/year from 2015 with 94.8% SVR. We project the impact of current and scaled-up HCV treatment for PLWH on HCV prevalence and incidence among PLWH and overall. Current treatment rates among PLWH (scaled-up since 2015) could substantially reduce the number of diagnosed coinfected individuals (mean 76% relative reduction from 2015 to 2030), but have little impact on new diagnosed coinfections (12% relative reduction). However, DAA scale-up to PWLH in 2015 would have minimal future impact on new diagnosed coinfections (mean 9% relative decrease from 2015 to 2030). Similarly, new cases of HCV would only reduce by a mean relative 29% among all PWID and MSM due to ongoing infection/reinfection. Diagnosing/treating all PLWH annually from 2020 would increase the number of new HCV infections among PWLH by 28% and reduce the number of new HCV infections by 39% among the broader population by 2030. Targeted scale-up of HCV treatment to PLWH can dramatically reduce prevalence among this group but will likely have little impact on the annual number of newly diagnosed HIV/HCV coinfections. HCV microelimination efforts among PWLH in Andalusia and settings where a large proportion of PLWH have a history of injecting drug use will require scaled-up HCV diagnosis and treatment among PLWH and the broader population at risk.