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. Â Clinical Infectious Disease.
Braun et al. aimed to test whether the world health organization (WHO) hepatitis C virus (HCV) elimination targets are achievable in clinical practice among men who have sex with men (MSM) living with HIV in the Swiss HIV Cohort Study (SHCS).
During phase A (10/2015–06/2016), they performed a population-based and systematic screening for HCV-RNA among MSM from the SHCS. During phase B (06/2016–02/2017) they offered treatment with HCV direct-acting antiviral (DAA) agents to MSM identified with a replicating HCV infection. During phase C (03/2017–11/2017), they offered rescreening to all MSM for HCV-RNA and initiated DAA treatment in MSM with replicating infections. Incident genotype 1a HCV infections identified during phase C were sequenced to build phylogenetic trees.
During phase A, they screened 3715/4640 (80%) MSM and identified 177 with replicating HCV infections (4.8%); 150 (85%) of whom started DAA treatment and 149 (99.3%) were cured. During phase B, they rescreened 2930/3538 (83%) MSM with a prior negative HCV-RNA and identified 13 (0.4%) with a new HCV infection, reflecting a 57% decrease in incident HCV infections. At the end of the micro-elimination program, 176/190 MSM (93%) were cured, and the HCV incidence rate declined from .53 per 100 patient-years (95% CI, .35–.83) prior to the intervention to .12 (95% CI, .03–.49) by the end of 2019. Out of the six sequenced genotype 1a strains, 4 sequences were classified as corresponding to international transmissions.
In conclusion, the study-results demonstrate the feasibility of a comprehensive systematic test, treat, and cure HCV micro-elimination program among MSM living with HIV. This approach could be proposed as a model to reach the WHO targets towards HCV micro-elimination in a setting with necessary resources. The fact that a substantial part of incident HCV infections occurred within international transmission networks shows that phylogenetic analysis is key to understanding the epidemic. Likewise, it emphasizes the need for cross-international efforts to reach the WHO elimination goals. Finally, HCV-RNA–based screening with timely diagnosis and treatment initiation is crucial among high-risk MSM to reduce onward transmission and to contain the HCV epidemic in the long run.