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Scaling up screening and treatment for elimination of hepatitis C among men who have sex with men in the era of HIV pre-exposure prophylaxis - PubMed

  • ️Tue Jan 01 2019

Scaling up screening and treatment for elimination of hepatitis C among men who have sex with men in the era of HIV pre-exposure prophylaxis

Louis Macgregor et al. EClinicalMedicine. 2019.

Abstract

Background: Routine HIV pre-exposure prophylaxis (PrEP) and HIV care appointments provide opportunities for screening men who have sex with men (MSM) for hepatitis C virus infection (HCV). However, levels of screening required for achieving the WHO elimination target of reducing HCV incidence by 90% by 2030 among all MSM are unknown.

Methods: An HCV/HIV transmission model was calibrated to UK prevalence of HIV among MSM (4·7%) and chronic HCV infection among HIV-positive MSM (9·9%) and HIV-negative MSM (1.2%). Assuming 12·5% coverage of PrEP among HIV-negative MSM, we evaluated the relative reduction in overall HCV incidence by 2030 (compared to 2018 levels) of HCV screening every 12/6-months (alongside completing direct acting antiviral treatment within 6-months of diagnosis) in PrEP users and/or HIV-diagnosed MSM. We estimated the additional screening required among HIV-negative non-PrEP users to reduce overall incidence by 90% by 2030. The effect of 50% reduction in condom use among PrEP users (risk compensation) was estimated.

Results: Screening and treating PrEP users for HCV every 12 or 6-months decreases HCV incidence by 67·3% (uncertainty range 52·7-79·2%) or 70·2% (57·1-80·8%), respectively, increasing to 75·4% (59·0-88·6%) or 78·8% (63·9-90·4%) if HIV-diagnosed MSM are also screened at same frequencies. Risk compensation reduces these latter projections by <10%. To reduce HCV incidence by 90% by 2030 without risk compensation, HIV-negative non-PrEP users require screening every 5·6 (3·8-9·2) years if MSM on PrEP and HIV-diagnosed MSM are screened every 6-months, shortening to 4·4 (3·1-6·6) years with risk compensation. For 25·0% PrEP coverage, the HCV elimination target can be reached without screening HIV-negative MSM not on PrEP, irrespective of risk compensation.

Interpretation: At low PrEP coverage, increased screening of all MSM is required to achieve the WHO HCV-elimination targets for MSM in the UK, whereas at higher PrEP coverage this is possible through just screening HIV-diagnosed MSM and PrEP users.

Keywords: ART, Anti-retroviral therapy; Antiviral treatment; DAA, Direct acting antiviral; EMIS, The European Men-Who-Have-Sex-With-Men Internet Survey; HCV, Hepatitis C virus; HIV; HIV, Human immunodeficiency virus; Hepatitis C virus; MSM, Men who have sex with men; Men who have sex with men; NHS, National Health Service; PLHIV, People living with HIV; PrEP, Pre-exposure prophylaxis; Pre-exposure prophylaxis; Prevention; Risk compensation; STIs, Sexually transmitted infections; UK CHIC, UK Collaborative HIV Cohort; WHO, World Health organisation.

© 2019 Published by Elsevier Ltd.

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Conflict of interest statement

NKM has received unrestricted research grants from Gilead, and honoraria from Gilead. NKM has also received honorarium of Merck. MH personal fees from MSM Gilead and Jansen. JN has recieved research grants from Gilead Sciences Europe. PV has received unrestricted research grants off Gilead, and honoraria off Gilead and Abbvie. LM, MD, FH and PW have nothing to declare.

Figures

Fig 1
Fig. 1

Projections of HCV (A) prevalence and (B) incidence among different subgroups of MSM by 2030 for the baseline ‘no PrEP’ scenario and due to the introduction of PrEP both with and without risk compensation. The projections assume 12·5% coverage of PrEP in HIV-negative MSM and no additional HCV screening. The risk compensation scenario assumes condom use among PrEP users reduces from 68% to 34%. Point estimates are the median of our model projections with the whiskers representing the 2·5 to 97·5 percentiles from our 500 model fits. *PrEP users at baseline are assumed to be representative of MSM who are eligible for PrEP in 2018.

Fig 2
Fig. 2

Relative reduction in HCV (A) prevalence and (B) incidence over 2018 to 2030 compared to 2018 levels among PrEP users when they are screened for HCV every 3, 6 or 12 months and complete HCV treatment within 6 months of diagnosis. Projections are given with and without risk compensation, with the risk compensation scenario assuming condom use among PrEP users reduces from 68% to 34%. The projections with no additional screening are also shown for comparison. Point estimates are the median of our model projections with the whiskers representing the 2·5 to 97·5 percentiles from our 500 model fits. *This is compared to the prevalence of HCV in MSM who are eligible for PrEP in 2018.

Fig 3
Fig. 3

Relative decrease in overall HCV incidence over 2018 to 2030 due to different HCV screening and treatment scenarios among MSM on PrEP and/or HIV-diagnosed MSM. MSM subgroups with enhanced screening also complete HCV treatment within 6 months of diagnosis. Projections are given (A) without and (B) with risk compensation, with the risk compensation scenario assuming condom use among PrEP users reduces from 68% to 34%. Dashed line in each figure gives change in HCV incidence by 2030 with no change in HCV screening. Point estimates are the median of our model projections with whiskers representing the 2·5 to 97·5 percentile range from our 500 model fits.

Fig 4
Fig. 4

Required duration between HCV screening tests among HIV-negative MSM not on PrEP (assuming 12·5% PrEP coverage) in order to reach a 90% HCV incidence reduction by 2030 compared to 2018 levels. HIV-diagnosed MSM and/or MSM on PrEP are screened every 3, 6 or 12 months, with all MSM subgroups completing HCV treatment within 6 months of diagnosis. Projections are given with and without risk compensation, with the risk compensation scenario assuming condom use among PrEP users reduces from 68% to 34%. Dashed line shows estimated current frequency of HIV testing in UK. Point estimates are the median of our model projections with whiskers representing the 2·5 to 97·5 percentile range from our 500 model fits.

Fig 5
Fig. 5

One-way sensitivity analysis on the (A) percentage reduction in HCV incidence over 2018 to 2030, and (B) the frequency of screening needed in HIV-negative non-PrEP users to reach an overall 90% reduction in HCV among MSM by 2030, given 6 monthly HCV screening in HIV-positive MSM and PrEP users. Scenario 0 shown for reference as point and whisker and grey vertical line. Point and whiskers represent the median values along with the 2·5 to 97·5 percentiles of the model projections across the 500 baseline model fits. *Note: the 25% PrEP coverage scenario and distribution of PrEP to only high-risk MSM is not shown in (B) because it does not require any screening in HIV-negative MSM not on PrEP to reach an overall 90% reduction in HCV among MSM by 2030.

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References

    1. Beyrer C., Baral S.D., van Griensven F. Global epidemiology of HIV infection in men who have sex with men. Lancet. 2012;380(9839):367–377. - PMC - PubMed
    1. Platt L., Easterbrook P., Gower E. Prevalence and burden of HCV co-infection in people living with HIV: a global systematic review and meta-analysis. Lancet Infect Dis. 2016;16(7):797–808. - PubMed
    1. Ghisla V., Scherrer A.U., Nicca D., Braun D.L., Fehr J.S. Incidence of hepatitis C in HIV positive and negative men who have sex with men 2000–2016: a systematic review and meta-analysis. Infection. 2017;45(3):309–321. - PubMed
    1. Danta M., Brown D., Bhagani S. Recent epidemic of acute hepatitis C virus in HIV-positive men who have sex with men linked to high-risk sexual behaviours. AIDS. 2007;21(8):983–991. - PubMed
    1. MacGregor L, Martin NK, Mukandavire C. Behavioural, not biological, factors drive the HCV epidemic among HIV-positive MSM: HCV and HIV modelling analysis including HCV treatment-as-prevention impact. Int J Epidemiol. 2017;46(5):1582–1592. - PMC - PubMed

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