Can HCV direct-acting antiviral treatment as prevention reverse the HCV epidemic amongst men who have sex with men in the UK - epidemiological and modelling insights

Martin, N. K. et al. (2016) Can HCV direct-acting antiviral treatment as prevention reverse the HCV epidemic amongst men who have sex with men in the UK - epidemiological and modelling insights. Clinical Infectious Diseases, 62(9), pp. 1072-1080. (doi:10.1093/cid/ciw075) (PMID:26908813) (PMCID:PMC4826456)

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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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Thomson, Dr Emma
Authors: Martin, N. K., Thornton, A., Hickman, M., Sabin, C., Nelson, M., Cooke, G. S., Martin, T. C.S., Delpech, V., Ruf, M., Price, H., Azad, Y., Thomson, E. C., and Vickerman, P.
College/School:College of Medical Veterinary and Life Sciences > Institute of Infection Immunity and Inflammation
Journal Name:Clinical Infectious Diseases
Publisher:Oxford University Press
ISSN:1058-4838
ISSN (Online):1537-6591
Published Online:16 February 2016
Copyright Holders:Copyright © 2016 The Authors
First Published:First published in Clinical Infectious Diseases 62(9):1072-1080
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
645101T-cell mediated evolution of hepatitis C virus during acute infectionEmma ThomsonWellcome Trust (WELLCOME)102789/Z/13/ZMVLS III - CENTRE FOR VIRUS RESEARCH