Broader access to direct-acting antivirals has been
accompanied by a decline or stabilisation in the rate of hepatitis C
reinfection in people with HIV and there is no evidence that reinfection is
undermining efforts to eliminate hepatitis C in this population, the
International Collaboration on Hepatitis C Elimination in HIV Cohorts reported
at the 24th International AIDS Conference (AIDS 2022) last month.
Hepatitis C can be cured by a short course of direct-acting
antiviral treatment and many countries have set ambitious targets to eliminate
hepatitis C infection as a public health problem by screening and treating
people for hepatitis C. People with HIV are a priority group for hepatitis C
elimination as the prevalence of hepatitis is high in this population and they
are relatively easy to reach through existing HIV care services.
Hepatitis C prevalence has risen among people with HIV over
the past 20 years owing to increased transmission among gay and bisexual men
living with HIV through condomless sex and injecting drug use. Concerns have
been raised that condomless sex coupled with a higher prevalence of untreated
hepatitis C could lead to a higher risk of reinfection with hepatitis C,
undermining efforts to eliminate hepatitis C among people with HIV.
The International Collaboration on Hepatitis C Elimination
in HIV Cohorts asked whether reinfection rates have changed as a result of
broader access to direct-acting antivirals.
To answer these questions, the researchers looked at data
from eight cohorts in six countries (Australia, Canada, France, the
Netherlands, Spain and Switzerland) between 2010 and 2019.
They calculated the incidence of first cases of reinfection
after treatment-induced or spontaneous clearance of hepatitis C in three
periods for each cohort: the period prior to direct-acting antiviral access,
the period when direct-acting antivirals were available on a limited basis, and
the period when direct-acting antivirals became available without restrictions.
These time-points varied between countries depending on reimbursement criteria
and national guidelines.
A total of 6195 people with virological evidence of hepatitis C
clearance and subsequent follow-up data were eligible for inclusion in the
analysis. Eighty-one per cent were male, 46% were gay or bisexual men and 34%
were people who inject drugs. The median age at hepatitis C clearance was 49
years.
During 13,527 person-years of follow-up, 790 reinfections
occurred in the cohorts. Compared to the pre-DAA period, incidence was 21%
lower in the limited-access period and 18% lower in the broad-access period.
The incidence of reinfection fell in all countries apart from Spain, where it
increased as time went on.
The incidence of reinfection was significantly lower in
people who inject drugs (-54%) compared to gay and bisexual men, suggesting that efforts to prevent reinfection should focus especially on gay and bisexual men.
The study investigators say that their findings suggest that
reinfection is unlikely to prove a major threat to hepatitis C elimination in
people with HIV.