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. 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.