08/07/17

Can We Treat HCV Away? Eliminating HCV among HIV-positive Men in Amsterdam

The ATHENA cohort (AIDS Therapy Evaluation in the Netherlands) is a group of
24,313 HIV-positive people who are followed at 26 national treatment centers. More than 99% of them have tested for hepatitis C virus (HCV) at least once. From 1984 until 2014, the incidence of acute HCV among HIV-positive men who have sex with men (MSM) rose significantly, from 0.8/1000 PY in 1984 to 11/1000 PY in 2014.

In November 2015, under the Dutch National Hepatitis Plan, the Netherlands provided unrestricted access to direct-acting antiviral (DAA) treatment for chronic HCV. Treatment for acute infection (the first 6 months), when HCV is most likely to be transmitted, was offered in clinical trials. HCV treatment uptake was rapid; by June 2017, 89% (910/1022) of all HIV-positive MSM in ATHENA had been treated for HCV; 83% were cured, while others were finishing treatment or follow-up. Each treatment center is working to ensure that 95% of all HIV/HCV coinfected MSM are treated with DAAs.

Data modeling suggests that treating and curing HCV can significantly decrease prevalence and incidence. The Dutch Acute HCV in HIV Study (DAHHS) is looking at the impact of HCV treatment on the incidence of acute HCV among HIV-positive MSM. In 2014, there were 93 acute HCV infections; in 2016, there were 49 acute HCV infections – a drop of 51%. Although DAA scale-up might not be responsible for this decrease, during the same time period the incidence of syphilis among HIV-positive MSM increased by 41%.

Reference:
Rijnders B. HCV in HIV+ men who have sex with men (MSM) in the Netherlands. 4th International HIV/Viral Hepatitis Co-infection Meeting. 22-23 July, Paris, France.

Source: Reporting from Paris for the PRN News: Tracy Swan