Broad Access to Direct-Acting Antivirals Reduces HCV Reinfections in Patients With HIV

Although the incidence of hepatitis C virus (HCV) reinfection in patients with HIV living in 6 different countries declined between 2010 and 2019 with the introduction of direct-acting antiviral (DAA) therapy and broad access to treatment, the relative contribution of reinfection to the total number of HCV diagnoses increased, indicating a concentration of infections in a subset of patients. These findings were published in The Lancet HIV.

Researchers conducted a multinational longitudinal study to assess changes in the incidence of HCV reinfection among at-risk patients with HIV infection during periods of limited and broad access to DAA therapy. Patients eligible for this study had confirmed HCV infection and were tested for reinfection at least once following spontaneous or treatment-induced virologic clearance. Three different access periods, occurring between 20010 and 2019, were defined: the pre-DAA period, the limited access period (restricted to those with moderate to severe liver disease and other high-risk groups), and the broad access period. Poisson regression was used to estimate changes in combined primary and subsequent reinfection incidence and the relative contribution of infection type by calendar year.

Of 6144 patients included in the final analysis, the median age was 49 (IQR, 42-54) years, 81% were men, 46% were men who have sex with men, and 38% reported injection drug use. Overall, the median time from first HCV positive test result to study baseline was 7 (IQR, 2-15) years, and the median follow-up duration was 2 (IQR, 1-4) years.   

The researchers found that the incidence of first HCV reinfection decreased after the introduction of DAA therapy. In the pre-DAA period, reinfection rates were stable at 4.1 episodes per 100 person-years (95% CI, 2.8-6.0). However, reinfection rates were 4% lower during the limited access period (incidence rate ratio [IRR], 0.96; 95% CI, 0.78-1.19 and 28% lower during the broad access period (IRR, 0.72; 95% CI, 0.60-0.86).

In all calendar years, most incident diagnoses were classified as primary HCV infections. Between 2015 and 2019, however, the proportion of HCV diagnoses attributable to reinfection increased from 23% to 41%. During that same time period, a 34% decline in combined HCV incidence (primary, first, and subsequent reinfections) was observed, aligning with the World Health Organization’s target of a 30% reduction in incidence.

Study limitations include the inability to adjust for behaviors related to recent sexual activity or injection drug use, the use of prospectively collected HCV testing data, and potential misclassification bias.

According to the researchers, “[T]he incidence of HCV reinfection and combined HCV incidence declined, consistent with a treatment-as-prevention effect, suggesting HCV reinfection is not a major threat to the achievement of HCV elimination targets among people with HIV…”

Disclosure: Multiple study authors declared affiliations with biotech, pharmaceutical, and or/device companies. Please see the original reference for a full list of disclosures.