Establishing a hepatitis C continuum of care among HIV/hepatitis C virus-coinfected individuals in EuroSIDA. HIV Medicine
Amele et al. within EuroSIDA assessed how many patients in a given population are hepatitis C positive, have a replicating HCV infection (HCV-RNA positive), receive treatment and are cured is of importance (also called the continuum of care).
The aim of this study was to establish a methodology for evaluating the hepatitis C continuum of care in HIV/hepatitis C virus (HCV)-coinfected individuals and to characterize the continuum in Europe on 1 January 2015, prior to widespread access to direct-acting antiviral (DAA) therapy.
The following stages included in the continuum were as follows:
- anti-HCV antibody positive,
- HCV RNA tested,
- currently HCV RNA positive,
- ever HCV RNA positive,
- ever received HCV treatment,
- completed HCV treatment,
- follow-up HCV RNA test, and
- cure.
Sustained virological response (SVR) could only be assessed for those with a follow-up HCV RNA test and was defined as a negative HCV RNA result measured >12 or 24 weeks after stopping treatment.
They found the following numbers and percentages for the stages of the HCV continuum of care within EuroSIDA:
- anti-HCV positive (n = 5173),
- HCV RNA tested (4207 of 5173; 81.3%),
- currently HCV RNA positive (3179 of 5173; 61.5%),
- ever HCV RNA positive (n = 3876),
- initiated HCV treatment (1693 of 3876; 43.7%),
- completed HCV treatment (1598 of 3876; 41.2%),
- follow-up HCV RNA test to allow SVR assessment (1’195 of 3876; 30.8%), and
- cure (629 of 3876; 16.2%).
The proportion that achieved SVR was 52.6% (629 of 1’195). There were significant differences between regions at each stage of the continuum (P <0.0001).
In conclusion, in the proposed HCV continuum of care for HIV/HCV-coinfected individuals, major gaps at all stages were found, with almost 20% of anti-HCV-positive individuals having no documented HCV RNA test and a low proportion achieving SVR, in the pre-DAA era.