Publication
A treatment as prevention trial to eliminate hepatitis C among men who have sex with men living with HIV in the Swiss HIV Cohort Study
Journal Paper/Review - Aug 6, 2020
Braun Dominique L, Schmid Patrick, Rougemont Mathieu, Delaloye Julie, Bernasconi Enos, Nicca Dunja, Böni Jürg, Rauch Andri, Kouyos Roger D, Günthard Huldrych F, Béguelin Charles, Stöckle Marcel, Hampel Benjamin, Ledergerber Bruno, Grube Christina, Nguyen Huyen, Künzler-Heule Patrizia, Shah Cyril, Salazar-Vizcaya Luisa, Conen Anna, Flepp Markus, Fehr Jan S
Units
PubMed
Doi
Citation
Type
Journal
Publication Date
Issn Electronic
Brief description/objective
BACKGROUND
In 2016, the World Health Organization (WHO) introduced global targets for the elimination of hepatitis C (HCV) by 2030. We conducted a nationwide HCV micro-elimination program among men who have sex with men (MSM) living with HIV from the Swiss HIV Cohort Study (SHCS) to test whether the WHO goals are achievable in this population.
METHODS
During phase A (10/2015-06/2016), we performed a population-based and systematic screening for HCV-RNA among MSM from the SHCS. During phase B (06/2016-02/2017) we offered treatment with HCV direct-acting agents (DAAs) to MSM identified with a replicating HCV infection. During phase C (03/2017-11/2017), we offered re-screen to all MSM for HCV-RNA and initiated DAA treatment in MSM with replicating infections (Clinicaltrials.gov NCT02785666).
FINDINGS
We screened 3'715/4'640 (80%) MSM and identified 177 with replicating HCV infections (4.8%); 150 (85%) of which started DAA treatment and 149 (99.3%) were cured. We re-screened 2'930/3'538 (83%) MSM with a prior negative HCV-RNA and identified 13 (0.4%) with a new HCV infection. At the end of the micro-elimination program, 176/190 MSM (93%) were cured, and the HCV incidence rate declined from 0.53 per 100 patient-years (95% confidence interval [CI] 0.35, 0.83) prior to the intervention to 0.12 (CI 0.03, 0.49) by the end of 2019.
INTERPRETATION
A systematic and population-based HCV micro-elimination program among MSM living with HIV was feasible and resulted in a strong decline in HCV incidence and prevalence. Our study can serve as a model for other countries aiming to achieve the WHO HCV elimination targets.