Hepatitis C disproportionately affects gay, bisexual, and
other men who have sex with men living with HIV. A smaller number of
HIV-negative gay and bisexual men – particularly those taking HIV
pre-exposure prophylaxis (PrEP) – are also affected. Common risk factors
include condomless anal sex, sexualised drug use, sharing injecting and
other drug equipment, fisting and sharing sex toys.
The introduction of direct-acting antivirals has simplified
and improved hepatitis C treatment significantly – over 90% of people
who take them are fully cured of the infection. This contrasts with
prior treatments, which lasted for a year, produced many side effects,
and only resulted in a cure rate of 50 to 60%. Additionally, the
efficacy of direct-acting antivirals is not affected by HIV status.
Based on the success of direct-acting antivirals to reduce
rates of hepatitis C, the World Health Organization set a goal of 80%
incidence reduction by 2030, relative to a 2015 baseline. With targeted
resources, this can be achieved faster in highly affected subgroups,
such as gay and bisexual men living with HIV.
There are studies that have looked at national-level
changes in hepatitis C incidence among gay and bisexual men with HIV
after introducing direct-acting antivirals. Some examples include France, the Netherlands, Switzerland and England. However, there have been no published studies looking at hepatitis C incidence among HIV-negative PrEP users.
In Australia, both medications became broadly available
from 2016 after the government subsidised direct-acting antivirals, with
no restrictions on treatment based on liver disease stage, substance
use, or reinfection status.
The treatment could also be prescribed by nonspecialist
primary care providers, and was made available in general practices and
sexual health clinics.
PrEP, which was initially available to 7500 people
(predominantly gay and bisexual men) through implementation trials in
2016, also became widely accessible in 2018 through government
subsidisation and general practitioner prescriptions