HCV Incidence Down Nearly 70% Among Men With HIV Living in London and Brighton

A recent report by Public Health England presented figures showing that new HIV transmissions have been falling in the United Kingdom since a peak in 2014.

A new study published in Clinical Infectious Diseases shows that from 2013 to 2018, new cases of hepatitis C virus (HCV) fell 68% among men living with HIV in London and Brighton.

The study team credits increased access to direct-acting antiviral therapies and expansions of screening in these cities for the dramatic impact on HCV incidence.

The investigators conducted a retrospective cohort study at 5 HIV clinics in London and Brighton between July 2013 and June 2018. Direct-acting antiviral therapies were made available in the National Health Service (NHS) treatment program in 2016 for chronic HCV infection.

The 5 clinics contributed data from 9728 men living with HIV. During the study period, the total number of men living with HIV in the cohort increased from 8053 to 8630.

There were 378 acute HCV infections identified. Of these, 292 were initial infections and 86 were reinfections.

The incidence rate of acute HCV in men living with HIV peaked in late 2015 at 14.57/1000 [95% CI, 10.95-18.20].

“In part, this likely reflects a steadily rising incidence over the previous decade, a trend that modeling studies predicted would continue in the absence of any new intervention. However, it is also possible that a reduction in rates of PEG IFN-based treatments in anticipation of DAAs [direct-acting antivirals] becoming available, referred to as ‘warehousing,’ potentially prolonged viremia and increased transmission,” the study authors wrote.

By 2018, the incidence rate had fallen to 4.63/1000 (95% CI, 2.60-6.67).

Study authors explained that this decline “coincided with the availability of DAA therapies from 2016 through the NHS, a single public sector health provider that offers universal coverage to those in need of treatment.”

The study team cautioned that their results may not be nationally applicable. A distinguishing feature of the London and Brighton clinics is that patients have access to enrollment in acute HCV clinical trials, leading to early treatment access.

“Shorter times to start treatment were observed most frequently in those who accessed HCV clinical trials,” the authors wrote.

The study team was optimistic that the analysis contains evidence significant declines in acute HCV incidence are possible. However, in concluding, they expressed concerns that after the post-2015 warehousing effect and decline, incidence has reached a plateau. The results, they pointed out, still fall short of World Health Organization targets.

The investigators suggested that better surveillance and earlier access to public sector treatment, including for reinfections, will be important to make further progress in the UK.

In the United States, HCV-associated mortality has continued to decline in recent years, but gaps remain when it comes to several at-risk groups.

A study comparing national trends with various subpopulations in the United States identified disproportionately higher HCV-associated mortality in the southern and western regions and among non-Hispanic American Indians/Alaska Natives, non-Hispanic blacks, and Baby Boomers.