HCV Declines Level Off in HIV+ Men Who Have Sex With Men

By Anne Harding

January 11, 2021

NEW YORK (Reuters Health) - The incidence of hepatitis C virus (HCV) infection among HIV-positive men who have sex with men in the Netherlands fell once direct-acting antivirals (DAAs) became universally available in 2015, new findings show.

While the data are "encouraging," infection rates in men who have sex with men (MSM) are "really still quite high," Dr. Anders Boyd of Stichting HIV Monitoring at Amsterdam University Medical Center told Reuters Health in a video call.

Dr. Boyd and his team looked at adults seen at HIV treatment centers in the Netherlands in 2000-2019. During the study, 1,269 cases of primary HCV were identified in 23,590 patients (5.2 per 1,000 person-years). MSM had the highest incidence, at 7.7 per 1,000 person-years, while the incidence was 1.7 per 1,000 person-years for people who inject drugs (PWID).

In 2007, the incidence of HCV in MSM was 14.3 per 1,000 person-years, while it ranged from 8.7 to 13.0 per 1,000 person-years over 2008-2015. In 2016, incidence fell to 6.1 per 1,000 person-years, and remained at 4.1-4.9 per 1,000 person-years from 2017-2019, Dr. Boyd and his colleagues report in The Lancet HIV.

There were 274 HCV reinfections in 1,866 HIV patients who had been infected previously (26.9 per 1,000 person-years). MSM had the highest incidence rate, at 38.5 per 1,000 person-years, while incidence was 10.9 per 1,000 person-years for PWID.

MSM's reinfection rate varied from 38.0 to 88.9 per 1,000 person-years in 2006-2015. Reinfection incidence was 55.6 per 1,000 person-years in 2015, and fell to 41.4 in 2016, further declining to 24.4 in 2017 and 11.4 in 2019.

From 2015 to 2019, the researchers note, primary HCV incidence declined by 61% in MSM with HIV, while reinfections fell by 79%. That falls short of the World Health Organization's target of an 80% reduction in HCV incidence from 2015 to 2030.

"It doesn't seem like we're going to get any further decline in that incidence," Dr. Boyd said. He noted that "slamming," or injecting drugs for sexual enhancement, as well as practices including condomless anal sex, remain relatively common among MSM.

"These are the types of activities that are contributing to the transmission of hepatitis C," he added. "There has been really no substantial decline in these behaviors over the past 10 years."

Dr. Boyd and his colleagues have received funding to investigate ways to "break the chain of hepatitis C transmission," he added, such as increasing testing and investigating why patients aren't receiving treatment, as well as an application that would coach users on how to reduce behaviors associated with hepatitis C transmission.

Dr. Geoffrey Dusheiko, an emeritus professor of medicine at University College London School of Medicine and Kings College Hospital, co-authored an editorial accompanying the study.

While the results are encouraging, Dr. Dusheiko told Reuters Health in a Zoom call, "there are some concerning features, particularly the fact that yearly testing should be increased. There seems to be, at least from the point of view of those who are reinfected, a falloff in yearly testing."

"We shouldn't drop our guard. There is a need to ensure high rates of hepatitis C testing to quickly detect seroconversion," he added. "These individuals need to be treated quickly because during the time that they're viremic, hepatitis C remains transmissible, particularly in those with high-risk sexual behaviors."

More research is needed to understand these behaviors, he added, and develop appropriate interventions to prevent reinfection in MSM.

SOURCE: https://bit.ly/3beTstD and https://bit.ly/2LphHKX The Lancet HIV, online December 22, 2020.