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Acute HCV decreasing in men who have sex with men with HIV

The rates of hepatitis C incidence among men who have sex with men with HIV has significantly decreased in London since the epidemic peak in 2015, coinciding with wider access to direct-acting antiviral therapy, according to data presented at CROI.

“The WHO aims to reduce by 90% the number of new infections of the next decade. Micro-elimination of well-defined populations has been suggested as an initial approach and, in the U.K., the British HIV Association ambitiously aims to cure all hepatitis C coinfection by 2021,” Lucy J. Garvey, MD(Res), MRCP, from the Imperial College Healthcare NHS Trust in London, said during her presentation. “If we consider the HIV-positive MSM population as a potential for micro-elimination, modeling work has predicted that significant scale-up of treatment including access for recent infection plus risk reduction work will all be important if these reductions in incidence are to be achieved.”

Between the “pre-DAA” period of 2013 and post-DAA period of 2018, Garvey and colleagues found 256 acute diagnoses of HCV including 211 first infections and 45 reinfections. Incidence peaked at 17 per 1,000 acute infections among HIV-positive MSM in 2015.

“The peak in 2015 most likely represents a fall-off in rates of interferon-based treatments as patients and clinicians awaited DAAs, a so-called 'warehousing effect' which may have increased HCV transmission by prolonging the duration of viremia,” Garvey said.

In 2018, all acute infections in this population decreased by 68% and first infections decreased by 79%. However, reinfection rates appear to have increased in recent years representing 47% of all infections in 2018.

Garvey noted that average time between acute HCV diagnosis and treatment initiation also decreased from 41 months in 2013 to 3 months in 2018, “largely driven by clinical trial availability,” she said.

“We have observed a sharp decline in new acute HCV diagnoses since the peak in 2015 with no change to screening practices,” Garvey concluded. “Nevertheless, the reduction in incidence still falls short of the WHO target to reduce new infections by 90%. Reinfection remains high and may be increasing, which highlights the ongoing need to promote and improve risk reduction strategies and design appropriate screening policies in HIV-positive and -negative MSM. Without expanding access of DAAs, progress in reducing incidence may plateau and the opportunity for HCV micro-elimination in HIV-positive MSM may be lost.” – by Talitha Bennett

Reference: Garvey LJ, et al. Abstract 85. Presented at: Conference on Retroviruses and Opportunistic Infections; March 4-7, 2019; Seattle.

Disclosure: Garvey reports no relevant financial disclosures.