On the potential of a short-term intensive intervention to interrupt HCV transmission in HIV-positive men who have sex with men: a mathematical modelling study. Journal of Viral Hepatitis
Salazar-Vizcaya et al. assessed the potential to interrupt hepatitis C virus (HCV) transmission among HCV-positive men who have sex with men (MSM) of the Swiss-HCVree-trial and a similar intensive intervention where all HCV genotypes could be treated. To capture potential changes outside intensive interventions, the authors varied time from HCV infection to treatment in clinical routine and overall high-risk behaviour among HIV-positive MSM.
In their model, the simulated prevalence dropped from 5.5% in 2016 to ≤2.0% over the intervention period (June/2016-May/2017) with the pangenotypic intervention, and to ≤3.6% with the Swiss-HCVree-trial. Assuming time to treatment in clinical routine reflected reimbursement restrictions at the time of the model simulation (METAVIR ≥F2, 16.9 years) and stable high-risk behaviour in the overall MSM population, prevalence in 2025 reached 13.1% without intensive intervention, 11.1% with the pangenotypic intervention and 11.8% with the Swiss-HCVree-trial. If time to treatment in clinical routine was 2 years, prevalence in 2025 declined to 4.8% without intensive intervention, to 2.8% with the pangenotypic intervention, and to 3.5% with the Swiss-HCVree-trial. In this scenario, the pangenotypic intervention and the Swiss-HCVree-trial reduced cumulative (2016-2025) treatment episodes by 36% and 24%, respectively.
In conclusion, the model projections suggest that a 1-year intensive intervention could save HCV treatment costs while boosting the benefits of long-term efforts to prevent high-risk behaviour and to increase treatment rate in clinical routine. In the scenario where treatment reimbursement restrictions were not relieved and the level of high-risk behaviour in the overall HIV-positive MSM population did not decrease, HCV prevalence doubled by 2025 despite intensive interventions. The study-results underscore the importance of the achievement of universal access to treatment with newest HCV direct acting agents for all HCV positive individuals with regard to HCV elimination in Switzerland.