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Clin Infect Dis. 2019 Oct 4. pii: ciz985. doi: 10.1093/cid/ciz985. [Epub ahead of print]

Moving towards hepatitis C micro-elimination among people living with HIV in Australia: the CEASE study.

Author information

1
The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
2
St Vincent's Hospital, Sydney, NSW, Australia.
3
Blacktown Mt Druitt Hospital, Blacktown, NSW, Australia.
4
Kirketon Road Clinic, Sydney, NSW, Australia.
5
East Sydney Doctors, Sydney, NSW, Australia.
6
The Albion Centre, Sydney, NSW, Australia.
7
Prince of Wales Hospital, Sydney, NSW, Australia.
8
Prince of Wales Clinical School, UNSW Sydney, Sydney, NSW, Australia.
9
Taylor Square Private Clinic, Sydney, NSW, Australia.
10
Holdsworth House Medical Practice, Sydney, NSW, Australia.
11
Burnet Institute, Melbourne, VIC, Australia.
12
Royal Adelaide Hospital, Adelaide, SA, Australia.
13
Alfred Hospital, Melbourne, Vic, Australia.

Abstract

BACKGROUND:

Micro-elimination of HCV among people living with HIV may be feasible in Australia, given unrestricted access to direct-acting antiviral (DAA) therapy from 2016. Our aim was to evaluate progress towards elimination goals within HIV/HCV co-infected adults in Australia following universal DAA access.

METHODS:

The CEASE prospective cohort study enrolled HIV/HCV positive adults, irrespective of viremic status, from 14 primary and tertiary clinics in Australia. Annual and cumulative HCV treatment uptake, outcome, and HCV RNA prevalence were evaluated, with follow-up through May 2018 (median follow-up: 2.63 years). Factors associated with DAA uptake were analysed.

RESULTS:

Between July 2014 and March 2017, 402 HIV/HCV antibody-positive participants were enrolled (95% male [80% gay and bisexual men,], 13% cirrhosis, 80% history of injecting drug use [39% current injecting]). Following universal DAA access, annual HCV treatment uptake in those eligible increased from 7% and 11% per year in 2014 and 2015, respectively, to 80% in 2016. By 2018, cumulative HCV treatment uptake in those ever eligible for treatment was 91% (336/371). HCV viremic prevalence declined from 82% (95%CI 78%, 86%) in 2014 to 8% (95%CI 6%, 12%) in 2018. Reinfection was reported in only five participants for a reinfection incidence of 0.81 per 100-person years (95% CI 0.34, 1.94).

CONCLUSIONS:

High uptake and effectiveness of unrestricted DAA therapy in Australia has permitted rapid treatment scale-up, with a dramatic reduction in HCV infection burden and low reinfection rate among people living with HIV, suggesting that micro-elimination is feasible.

KEYWORDS:

HIV; Hepatitis C; elimination; men-who-have-sex-with-men; treatment-as-prevention

PMID:
31585005
DOI:
10.1093/cid/ciz985

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