Increased case-finding and uptake of direct-acting antiviral treatment essential for micro-elimination of hepatitis C among people living with HIV: a national record linkage study

Allan McLeod*, Sharon J. Hutchinson, Shanley Smith, Clifford Leen, Sarah Clifford, Andrew McAuley, Lesley A. Wallace, Stephen T. Barclay, Peter Bramley, John F. Dillon, Andrew Fraser, Rory N. Gunson, Peter C. Hayes, Nick Kennedy, Erica Peters, Kate Templeton, David J. Goldberg

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives
Micro-elimination of hepatitis C virus (HCV) in people living with HIV (PLHIV) and co-infected with HCV has been proposed as a key contribution to the overall goal of HCV elimination. While other studies have examined micro-elimination in HIV treated cohorts, few have considered HCV micro-elimination among those not treated for HIV or at a national level.
Methods
Through data linkage of national and sentinel surveillance data, we examined extent of HCV testing, diagnosis, and treatment among a cohort of PLHIV in Scotland identified through the national database of HIV diagnosed individuals, to the end of 2017.
Results
Of 5018 PLHIV, an estimated 797 (15%) had never been tested for HCV and 70 (9%) of these had undiagnosed chronic HCV. Odds of never being tested for HCV were highest in those not on HIV treatment (adjusted Odds Ratio = 7.21, 95% CI 5.15- 10.10). Overall HCV antibody positivity was 11% and highest among people who inject drugs (PWID) at 49%. Most (91%) of those with chronic HCV had attended an HCV treatment clinic but only half had been successfully treated (54% for those on HIV treatment, 12% for those not) by the end of 2017. Odds of never being treated for HCV were highest in those not on HIV treatment (aOR= 3.60, 95% CI 1.59 - 8.15).
Conclusions
Our data demonstrate that micro-elimination of HCV in PLHIV is achievable but progress will require increased effort to engage and treat those co-infected, including those not being treated for their HIV.
Original languageEnglish
JournalHIV Medicine
Publication statusAccepted/In press - 28 Oct 2020

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