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Clin Infect Dis. 2016 May 1;62(9):1072-1080. doi: 10.1093/cid/ciw075. Epub 2016 Feb 16.

Can Hepatitis C Virus (HCV) Direct-Acting Antiviral Treatment as Prevention Reverse the HCV Epidemic Among Men Who Have Sex With Men in the United Kingdom? Epidemiological and Modeling Insights.

Author information

1
Division of Global Public Health, University of California San Diego.
2
School of Social and Community Medicine, University of Bristol.
3
University College London.
4
Chelsea and Westminster Hospital.
5
Imperial College.
6
Public Health England, Colindale.
7
Medical Affairs, Gilead SciencesLtd, London.
8
Mid Essex Hospital Services NHS Trust, Chelmsford.
9
National AIDS Trust, London.
10
MRC University of Glasgow Centre for Virus Research, United Kingdom.

Abstract

BACKGROUND:

We report on the hepatitis C virus (HCV) epidemic among human immunodeficiency virus (HIV)-positive men who have sex with men (MSM) in the United Kingdom and model its trajectory with or without scaled-up HCV direct-acting antivirals (DAAs).

METHODS:

A dynamic HCV transmission model among HIV-diagnosed MSM in the United Kingdom was calibrated to HCV prevalence (antibody [Ab] or RNA positive), incidence, and treatment from 2004 to 2011 among HIV-diagnosed MSM in the UK Collaborative HIV Cohort (UK CHIC). The epidemic was projected with current or scaled-up HCV treatment, with or without a 20% behavioral risk reduction.

RESULTS:

HCV prevalence among HIV-positive MSM in UK CHIC increased from 7.3% in 2004 to 9.9% in 2011, whereas primary incidence was flat (1.02-1.38 per 100 person-years). Over the next decade, modeling suggests 94% of infections are attributable to high-risk individuals, comprising 7% of the population. Without treatment, HCV chronic prevalence could have been 38% higher in 2015 (11.9% vs 8.6%). With current treatment and sustained virological response rates (status quo), chronic prevalence is likely to increase to 11% by 2025, but stabilize with DAA introduction in 2015. With DAA scale-up to 80% within 1 year of diagnosis (regardless of disease stage), and 20% per year thereafter, chronic prevalence could decline by 71% (to 3.2%) compared to status quo in 2025. With additional behavioral interventions, chronic prevalence could decline further to <2.5% by 2025.

CONCLUSIONS:

Epidemiological data and modeling suggest a continuing HCV epidemic among HIV-diagnosed MSM in the United Kingdom driven by high-risk individuals, despite high treatment rates. Substantial reductions in HCV transmission could be achieved through scale-up of DAAs and moderately effective behavioral interventions.

KEYWORDS:

HIV; antiviral treatment; hepatitis C virus; men who have sex with men; prevention

PMID:
26908813
PMCID:
PMC4826456
DOI:
10.1093/cid/ciw075
[Indexed for MEDLINE]
Free PMC Article

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