Impact of direct-acting antivirals on the burden of HCV infection among persons who inject drugs and men who have sex with men in the Swiss HIV Cohort Study. Open Forum Infectious Diseases
Salazar-Vizcaya et al. aimed to describe and compare direct-acting antivirals (DAA) upscale and its impact on the number of replicating hepatitis C virus (HCV) infections among people who inject drugs (PWID) and men who have sex with men (MSM) in the Swiss HIV Cohort Study (SHCS).
Five thousand two hundred sixty-seven MSM and 1’805 PWID were followed by the SHCS over the study period, resulting in 38’693 and 14’748 person-years of follow-up for MSM and PWID, respectively.
- The incidence of DAA treatments increased rapidly from 2012 on and reached 28.3 and 17.6/100 person-years (py) for PWID and MSM, respectively, in 2016.
- In MSM, the incidence of primary infections increased from 0.2/100 (95% CI: 0.1–0.5) to 0.9/100 (95% CI: 0.4–1.9) py. In PWID, there was only 1 case of primary infection since 2012.
- The incidence of reinfection increased in MSM (from 0/100 [95% CI: 0–242.3] to 9.5/100 [95% CI: 0.2–53.1]), whereas it decreased 3-fold in PWID (from 13/100 [95% CI: 2.7–38.0] to 4.7/100 [95% CI: 0.6–16.8]).
- The number of patients with replicating HCV infection consistently declined in PWID (from 889 to 351), whereas it increased in MSM (from 62 to 110).
In conclusion, the increase in treatment uptake and efficacy observed after the approval of DAAs boosted the decline of replicating HCV infections among PWID in the SHCS. However, among MSM, the potential beneficial impact of new treatments was counterbalanced by the high rate of incident HCV infections and by postponing treatment because of reimbursement limitations.