The hepatitis C cascade of care in HIV/hepatitis C virus coinfected individuals in Europe: regional and intra-regional differences. AIDS
Fursa et al. aimed to identify gaps in the care for individuals with HIV and hepatitis C virus (HCV) infection in the EuroSIDA cohort. Using the cascade of care method, the authors monitored the progress towards the WHO target of diagnosing 90% of all individuals with HCV coinfection, and treating 80% of those diagnosed.
The cascade of care described (1) the number of anti-HCV antibody positive individuals, (2) the proportion of individuals who ever had an HCV-RNA test, and (3) the proportion of individuals currently HCV-RNA positive. In addition, authors assessed the proportion of chronically infected individuals who ever started and completed anti-HCV treatment, respectively. The cascade of care was assessed separately for five European regions: South (e.g. Greece, Italy), Central-West (e.g. Switzerland, France), North (e.g. Denmark, Finland), Central-East (e.g. Poland, Romania), and East (e.g. Ukraine, Belarus).
Of 22’356 EuroSIDA participants, 20’437 (91.4%) ever had an anti-HCV antibody test, and 40.7% were anti-HCV positive. For this study, 4773 anti-HCV positive individuals under active follow-up were included (median age 42, IQR 38-46; 70% men; HIV transmission with injection drug use in 57% of cases). Of those, 4446 (93.1%) ever had HCV-RNA measured, of which 19% were HCV-RNA positive at the last visit closest to October 2019. HCV-RNA positivity ranged from 10% in Central-West to 33% in East Europe. Overall, 72.5% of all individuals estimated to have had chronic HCV infection ever started HCV treatment, with 98% of them having completed the treatment. The proportion of individuals who received treatment was highest in Central-Western Europe (85.1%), and lowest in Eastern Europe (46.7%). With a proportion of just below 80%, Switzerland had the lowest HCV treatment rate of the Central-Western region, thereby missing the WHO targets.
Taken together, the present study performed in the era of highly effective direct-acting antivirals revealed regional differences in the HCV cascade of care, with the largest gaps in HCV-RNA testing and treatment coverage detected in Eastern Europe. The detailed analysis in this pan-European cohort identified distinct regional and country level gaps, allowing stakeholders to take targeted actions to reach the WHO hepatitis C elimination targets.