Can Hepatitis C Virus (HCV) Direct-Acting Antiviral Treatment as Prevention Reverse the HCV Epidemic Among Men Who Have Sex With Men in the United Kingdom? Epidemiological and Modeling Insights

Article, Unknown English OPEN
Martin, Natasha K ; Thornton, Alicia ; Hickman, Matthew ; Sabin, Caroline ; Nelson, Mark ; Cooke, Graham S ; Martin, Thomas C S ; Delpech, Valerie ; Ruf, Murad ; Price, Huw ; Azad, Yusef ; Thomson, Emma C ; Vickerman, Peter (2016)
  • Publisher: Oxford University Press (OUP)
  • Journal: volume 62, issue 9, pages 1,072-1,080 (issn: 1058-4838, eissn: 1537-6591)
  • Related identifiers: pmc: PMC4826456, doi: 10.1093/cid/ciw075
  • Subject: Articles and Commentaries | /dk/atira/pure/researchoutput/pubmedpublicationtype/D016428 | /dk/atira/pure/researchoutput/pubmedpublicationtype/D013485 | 06 Biological Sciences | Microbiology | /dk/atira/pure/researchoutput/pubmedpublicationtype/D052061 | men who have sex with men | Research Support, Non-U.S. Gov't | hepatitis C virus | antiviral treatment | HIV | Research Support, N.I.H., Extramural | 11 Medical And Health Sciences | Journal Article | prevention
    mesheuropmc: virus diseases

<p><b><i>Background.</i></b> 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).</p><p><b><i>Methods.</i></b> 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.</p><p><b><i>Results.</i></b> 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 &lt;2.5% by 2025.</p><p><b><i>Conclusions.</i></b> 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.</p>
  • References (34)
    34 references, page 1 of 4

    1. Urbanus AT, van de Laar TJ, Stolte IG, et al. Hepatitis C virus infections among HIV-infected men who have sex with men: an expanding epidemic. AIDS 2009; 23:F1-7.

    2. van de Laar T, Pybus O, Bruisten S, et al. Evidence of a large, international network of HCV transmission in HIV-positive men who have sex with men. Gastroenterology 2009; 136:1609-17.

    3. Price H, Gilson R, Mercey D, et al. Hepatitis C in men who have sex with men in London-a community survey. HIV Med 2013; 14:578-80.

    4. Yaphe S, Bozinoff N, Kyle R, Shivkumar S, Pai N, Klein M. Incidence of acute hepatitis C virus infection among men who have sex with men with and without HIV infection: a systematic review. Sex Trans Infect 2012; 88:558-64.

    5. Giraudon I, Ruf M, Maguire H, et al. Increase in diagnosed newly acquired hepatitis C in HIV-positive men who have sex with men across London and Brighton, 2002-2006: is this an outbreak? Sex Transm Infect 2008; 84:111-6.

    6. Ruf M, Delpech V, Osuagwu U, Brown A, Robinson E, Chadborn T. Men who have sex with men: estimating the size of at-risk populations in London primary care trusts. Int J STD AIDS 2011; 22:25-9.

    7. Martin NK, Vickerman P, Grebely J, et al. HCV treatment for prevention among people who inject drugs: modeling treatment scale-up in the age of direct-acting antivirals. Hepatology 2013; 58:1598-609.

    8. Martin NK, Miners A, Vickerman P, et al. The cost-effectiveness of HCV antiviral treatment for injecting drug user populations. Hepatology 2012; 55:49-57.

    9. Martin NK, Vickerman P, Foster GR, Hutchinson SJ, Goldberg DJ, Hickman M. Can antiviral therapy for hepatitis C reduce the prevalence of HCV among injecting drug user populations? A modelling analysis of its prevention utility. J Hepatol 2011; 54:1137-44.

    10. Martin NK, Vickerman P, Dore GJ, Hickman M. The hepatitis C virus epidemics in key populations (including people who inject drugs, prisoners and MSM): the use of direct-acting antivirals as treatment for prevention. Curr Opin HIV AIDS 2015; 10:374-80.

  • Similar Research Results (2)
  • Metrics
    No metrics available