Hepatitis C care cascades for three populations at high risk: low-income trans women, young people who inject drugs, and men who have sex with men and inject drugs

Abstract Background To achieve elimination of hepatitis C virus (HCV) infection, limited resources can be best allocated through estimation of "care cascades" among groups disproportionately affected. In San Francisco and elsewhere, these groups include young (age ≤30 years) people who inject drugs (YPWID), men who have sex with men who inject drugs (MSM-IDU), and low-income trans women. Methods We developed cross-sectional HCV care cascades for YPWID, MSM-IDU, and trans women using diverse data sources. Population sizes were estimated using an inverse variance-weighted average of estimates from the peer-reviewed literature between 2013–2019. Proportions of past/current HCV infection, diagnosed infection, treatment initiation, and evidence of cure (sustained virologic response at 12 weeks post-treatment) were estimated from the literature using data from seven programs and studies in San Francisco between 2015-2020. Results The estimated number of YPWID in San Francisco was 3,748; 58.4% had past/current HCV infection, of whom 66.4% were diagnosed with current infection, 9.1% of whom had initiated treatment, and 50% had confirmed cure. The corresponding figures for the 8,135 estimated MSM-IDU were: 29.4% with past/current HCV infection, 70.3% diagnosed with current infection, 28.4% initiated treatment, and 38.9% with confirmed cure. For the estimated 951 low-income trans women, 24.8% had past/current HCV infection, 68.9% were diagnosed with current infection, 56.5% initiated treatment, and 75.5% had confirmed cure. Conclusions In all three populations, diagnosis rates were relatively high; however, attention is needed to urgently increase treatment initiation in all groups, with particular unmet need among YPWID.

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Progress toward closing gaps in the hepatitis C virus cascade of care for people who inject drugs in San Francisco

PLoS ONE ◽

10.1371/journal.pone.0249585 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0249585

Author(s):

Ali Mirzazadeh ◽

Yea-Hung Chen ◽

Jess Lin ◽

Katie Burk ◽

Erin C. Wilson ◽

...

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

San Francisco ◽

People Who Inject Drugs ◽

Sustained Viral Response ◽

Hcv Infection ◽

Similar Proportion ◽

P Value ◽

Hcv Treatment ◽

Data Tracking

Background People who inject drugs (PWID) are disproportionately affected by hepatitis C virus (HCV). Data tracking the engagement of PWID in the continuum of HCV care are needed to assess the reach, target the response, and gauge impact of HCV elimination efforts. Methods We analyzed data from the National HIV Behavioral Surveillance (NHBS) surveys of PWID recruited via respondent driven sampling (RDS) in San Francisco in 2018. We calculated the number and proportion who self-reported ever: (1) tested for HCV, (2) tested positive for HCV antibody, (3) diagnosed with HCV, (4) received HCV treatment, (5) and attained sustained viral response (SVR). To assess temporal changes, we compared 2018 estimates to those from the 2015 NHBS sample. Results Of 456 PWID interviewed in 2018, 88% had previously been tested for HCV, 63% tested antibody positive, and 50% were diagnosed with HCV infection. Of those diagnosed, 42% received treatment. Eighty-one percent of those who received treatment attained SVR. In 2015 a similar proportion of PWID were tested and received an HCV diagnosis, compared to 2018. However, HCV treatment was more prevalent in the 2018 sample (19% vs. 42%, P-value 0.01). Adjusted analysis of 2018 survey data showed having no health insurance (APR 1.6, P-value 0.01) and having no usual source of health care (APR 1.5, P-value 0.01) were significantly associated with untreated HCV prevalence. Conclusion While findings indicate an improvement in HCV treatment uptake among PWID in San Francisco, more than half of PWID diagnosed with HCV infection had not received HCV treatment in 2018. Policies and interventions to increase coverage are necessary, particularly among PWID who are uninsured and outside of regular care.

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Spontaneous viral clearance of hepatitis C virus (HCV) infection among people who inject drugs (PWID) and HIV-positive men who have sex with men (HIV+ MSM): a systematic review and meta-analysis

BMC Infectious Diseases ◽

10.1186/s12879-016-1807-5 ◽

2016 ◽

Vol 16 (1) ◽

Cited By ~ 19

Author(s):

Daniel J. Smith ◽

Ashly E. Jordan ◽

Mayu Frank ◽

Holly Hagan

Keyword(s):

Systematic Review ◽

Hepatitis C Virus ◽

Hepatitis C ◽

People Who Inject Drugs ◽

Meta Analysis ◽

Viral Clearance ◽

Hcv Infection ◽

Hiv Positive ◽

Spontaneous Viral Clearance ◽

Sex With Men

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Impact of Direct-Acting Antivirals on the Burden of HCV Infection Among Persons Who Inject Drugs and Men Who Have Sex With Men in the Swiss HIV Cohort Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy154 ◽

2018 ◽

Vol 5 (7) ◽

Cited By ~ 9

Author(s):

Luisa Salazar-Vizcaya ◽

Gilles Wandeler ◽

Jan Fehr ◽

Dominique Braun ◽

Matthias Cavassini ◽

...

Keyword(s):

Cohort Study ◽

Hepatitis C Virus ◽

Hepatitis C ◽

People Who Inject Drugs ◽

Hcv Infection ◽

Direct Acting Antivirals ◽

Persons Who Inject Drugs ◽

Sex With Men ◽

Direct Acting

Abstract In the Swiss HIV Cohort Study, the number of people who inject drugs with replicating hepatitis C virus (HCV) infection decreased substantially after the introduction of direct-acting antivirals (DAAs). Among men who have sex with men, the increase in DAA uptake and efficacy was counterbalanced by frequent incident HCV infections.

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Comparing men who have sex with men and inject drugs and people who inject drugs who are men and have sex with men in San Francisco: Implications for HIV and hepatitis C virus prevention

10.1101/2021.12.09.21267273 ◽

2021 ◽

Author(s):

Adelina Artenie ◽

Shelley N. Facente ◽

Sheena Patel ◽

Jack Stone ◽

Jennifer Hecht ◽

...

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

San Francisco ◽

People Who Inject Drugs ◽

Risk Behaviour ◽

Behavioural Surveillance ◽

Sociodemographic Risk ◽

History Of ◽

Male Sexual Partners ◽

Sex With Men

ABSTRACTBackgroundMen who have sex with men (MSM) and people who inject drugs (PWID) carry a disproportionate burden of HIV and hepatitis C virus (HCV) infections. We compared the demographic and risk profiles of MSM who inject drugs (MSM-IDU, i.e., men reached through affiliation with MSM) and PWID who are men and have sex with men (PWID-MSM, i.e., men reached through affiliation with PWID).MethodsWe used data from the most recent waves of the National HIV Behavioural Surveillance among MSM (2017) and PWID (2018) in San Francisco. Participants were recruited through venue-based (MSM) and peer-referral (PWID) sampling and completed standardised questionnaires. We compared the characteristics of MSM-IDU and PWID-MSM using bivariate tests.ResultsOf 504 participants completing the MSM survey, 6.2% reported past-year injection drug use (MSM-IDU). Among 311 male participants completing the PWID survey, 19.0% reported past-year sex with a male (PWID-MSM). Relative to MSM-IDU, more PWID-MSM were older, identified as bisexual, had lower income, a history of incarceration and were homeless. MSM-IDU had more male sexual partners (median: 10 vs 3) and fewer injected daily (29.0% vs 64.4%) than PWID-MSM. While more PWID-MSM sought sterile equipment from a syringe program (86.4% vs 35.5%), fewer reported using PrEP (15.0% vs 42.9%).ConclusionThe sociodemographic, risk behaviour, and prevention access profiles of MSM-IDU and PWID-MSM in San Francisco suggest that they represent distinct populations who may require tailored HIV and HCV prevention strategies. MSM- and PWID-focused prevention programs should provide combined sexual health and harm reduction messages and services.

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Hepatitis C Reinfection in People Who Inject Drugs in Resource-Limited Countries: A Systematic Review and Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17144951 ◽

2020 ◽

Vol 17 (14) ◽

pp. 4951

Author(s):

Abbe Muller ◽

David Vlahov ◽

Matthew J. Akiyama ◽

Ann Kurth

Keyword(s):

Systematic Review ◽

Hepatitis C ◽

Low Income ◽

People Who Inject Drugs ◽

Hcv Infection ◽

World Health ◽

Low Income Countries ◽

Reinfection Rate ◽

Middle Income ◽

Middle Income Countries

Hepatitis C (HCV) is a global pandemic. The World Health Organization has developed a strategic plan for HCV elimination that focuses on low- and middle-income countries (LMICs) and high-risk populations, including people who inject drugs (PWID). While direct-acting antiviral (DAA) therapies are highly effective at eliminating HCV infections and have few side effects, medical professionals and policymakers remain concerned about the risk of reinfection among PWID. This study is a systematic review of research measuring the rate of HCV reinfection among PWID in LMICs and identifies additional areas for further research. A systematic search strategy was used to identify studies documenting HCV reinfection after sustained virologic response in PWID in LMICs. We refined results to include studies where at least 50% of participants had DAA treatment for primary HCV infection. Pooled reinfection rate was calculated across all studies. Seven studies met eligibility criteria. Most studies were conducted in six upper middle-income countries (Mexico, Romania, Russia, Taiwan, Georgi, and Brazil) and one lower middle-income country (Bangladesh) with a total of 7665 participants. No study included information from PWID in low-income countries. Sample sizes ranged from 200 to 3004 individuals, with demographic data missing for most participants. Four studies used deep gene sequencing, and reflex genotyping procedures to differentiate reinfection (infection by a different HCV genotype/subtype) from virologic relapse (infection by the same strain). The follow-up time of people cured from primary chronic HCV infection ranged from 12 weeks to 6.6 years. The pooled reinfection rate of all seven studies was 2.8 (range: 0.02 to 10.5) cases per 100 person-years (PY). In the five studies that differentiated relapse from reinfection, the incidence of reinfection was 1.0 per 100 PY. To date, research on reinfection rates among PWID in LMICs remains limited. Research focused on PWID in low-income countries is particularly needed to inform clinical decision making and evidence-based programs. While rates of reinfection among PWID who complete DAA treatment in upper and lower middle-income countries were similar or lower than rates observed in PWID in high-income countries, the rates were highly variable and factors may influence the accuracy of these measurements. This systematic review identifies several areas for continued research. Policies concerning access to HCV testing and treatment should be comprehensive and not place restrictions on PWID in these settings.

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Hepatitis C virus infection in HIV-infected men who have sex with men: sustained rising incidence in Antwerp, Belgium, 2001–2009

Eurosurveillance ◽

10.2807/ese.15.39.19673-en ◽

2010 ◽

Vol 15 (39) ◽

Cited By ~ 1

Author(s):

E Bottieau ◽

L Apers ◽

M Van Esbroeck ◽

M Vandenbruaene ◽

E Florence

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Hcv Infection ◽

Hiv Positive ◽

Acute Hepatitis C ◽

Transmitted Infection ◽

Sexually Transmitted ◽

Awareness Campaigns ◽

Rising Incidence ◽

Sex With Men

During the last decade, outbreaks of acute hepatitis C virus (HCV) infection have been reported among human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) in several European countries. To study this emerging infection in MSM in Antwerp, Belgium, we reviewed all cases of newly acquired HCV infection in HIV-positive MSM followed from 2001 to 2009 at the HIV/sexually transmitted infection (STI) reference clinic of the Institute of Tropical Medicine in Antwerp. Newly acquired HCV infection was considered as certain or probable according to local definitions. During the study period, 69 episodes of newly acquired HCV infection (40 certain and 29 probable) were diagnosed in 67 HIV-infected MSM. In only 10 episodes (14%) were the patients symptomatic. The annual incidence of HCV infection in our population of HIV-infected MSM rose steadily from 0.2% in 2001 to 1.51% in 2008, and then peaked to 2.9% in 2009. For 60 episodes (87%), another STI (mainly syphilis and lymphogranuloma venereum) had been diagnosed within the six months before the diagnosis of HCV infection. All but one patient with available genotyping (n=54) were found to be infected with the difficult-to-treat HCV genotypes 1 or 4. Our results therefore demonstrate the rising incidence of HCV infection in HIV-positive MSM in Antwerp, since 2001, which reached an alarming level in 2009. Targeted awareness campaigns and routine screening are urgently needed to limit further HCV spread and its expected long-term consequences.

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A Treatment-as-Prevention Trial to Eliminate Hepatitis C Among Men Who Have Sex With Men Living With Human Immunodeficiency Virus (HIV) in the Swiss HIV Cohort Study

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1124 ◽

2020 ◽

Cited By ~ 2

Author(s):

Dominique L Braun ◽

Benjamin Hampel ◽

Bruno Ledergerber ◽

Christina Grube ◽

Huyen Nguyen ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Cohort Study ◽

Hepatitis C ◽

Population Based ◽

Hcv Infection ◽

World Health ◽

Treatment As Prevention ◽

Hcv Rna ◽

Immunodeficiency Virus ◽

Sex With Men

Abstract Background In 2016, the World Health Organization (WHO) introduced global targets for the elimination of hepatitis C virus (HCV) by 2030. We conducted a nationwide HCV micro-elimination program among men who have sex with men (MSM) living with human immunodeficiency virus (HIV) from the Swiss HIV Cohort Study (SHCS) to test whether the WHO goals are achievable in this population. Methods During phase A (10/2015–06/2016), we performed a population-based and systematic screening for HCV-RNA among MSM from the SHCS. During phase B (06/2016–02/2017) we offered treatment with HCV direct-acting antiviral (DAA) agents to MSM identified with a replicating HCV infection. During phase C (03/2017–11/2017), we offered rescreening to all MSM for HCV-RNA and initiated DAA treatment in MSM with replicating infections. Results We screened 3715/4640 (80%) MSM and identified 177 with replicating HCV infections (4.8%); 150 (85%) of whom started DAA treatment and 149 (99.3%) were cured. We rescreened 2930/3538 (83%) MSM with a prior negative HCV-RNA and identified 13 (0.4%) with a new HCV infection. At the end of the micro-elimination program, 176/190 MSM (93%) were cured, and the HCV incidence rate declined from .53 per 100 patient-years (95% CI, .35–.83) prior to the intervention to .12 (95% CI, .03–.49) by the end of 2019. Conclusions A systematic, population-based HCV micro-elimination program among MSM living with HIV was feasible and resulted in a strong decline in HCV incidence and prevalence. Our study can serve as a model for other countries aiming to achieve the WHO HCV elimination targets. Clinical Trials Registration NCT02785666.

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