Title: Is Hcv Elimination Among Hiv-Infected People Who Inject Drugs Possible Through Treating Hiv/Hcv Coinfection? A Modeling Analysis For Andalusia, Spain

Author: Skaathun B, Borquez A, Rivero-Juarez A, Mehta SR , Tellez F, Castaño M, Merino D, Santos J, Macías J, Rivero A, Martin NK

Theme: Epidemiology & Public Health Research Year: 2018

Background: Scale-up of hepatitis C virus (HCV) treatment for HIV/HCV coinfected individuals is occurring in Spain, the majority with a history of injecting drug use. We assess the implications for achieving the WHO HCV incidence elimination target (80% reduction from 2015-2030) among HIV-infected (HIV+) people who inject drugs (PWID) and all PWID in Andalusia, Spain, using dynamic modeling. Methods: A joint HIV and HCV transmission model among PWID was calibrated to Andalusia based on published data and the HERACLES cohort (prospective cohort of HIV/HCV coinfected individuals representing >99% coinfected individuals in care in Andalusia from 2015). We simulate: 45%/60% chronic HCV prevalence and 20%/40% HIV prevalence among PWID injecting for 10 years, respectively, 54% chronic HCV among HIV+ ever-PWID (PWID + ex-PWID). We assumed HCV treatment among diagnosed coinfected ever-PWID of 10.5%/year from 2004-2014, and 33%/year from 2015 (from HERACLES). We project the impact of current treatment, and scaled-up treatment (among HIV+ PWID or all PWID) from 2018 on HCV prevalence/incidence among HIV+ PWID and all PWID. Results: We project that 28% and 32% of HCV+ PWID and HCV+ ex-PWID, respectively, in Andalusia were HIV/HCV coinfected in 2015. Current treatment rates could reduce the number of diagnosed coinfected PWID by 75% from 2015-2030. However, this would only reduce HCV incidence by a relative 25% and 16% among HIV+ PWID and all PWID, respectively (Fig 1). If all coinfected PWID were diagnosed and treated annually from 2018, this could reduce chronic HCV prevalence by 74% among HIV+ PWID by 2030, but only halve incidence (Fig 1). Greater impact could be achieved through scaling-up treatment to all PWID. Conclusion: HCV elimination among HIV+ PWID in Andalusia will not be achieved by treating coinfected PWID alone; efforts should focus on HCV diagnosis and treatment among both coinfected and monoinfected PWID. Funding: This study was funded by Gilead Sciences. The funder had no role in the analysis or presentation of the results. NM and AB were additionally supported by the National Institute for Drug Abuse [grant number R01 DA037773]. NM had partial support from the University of California San Diego Center for AIDS Research (CFAR), a National Institute of Health (NIH) funded program [grant number P30 AI036214] which is supported by the following NIH Institutes and Centers: NIAID, NCI, NIMH, NIDA, NICHD, NHLBI, NIA NIGMS, and NIDDK. The views expressed are those of the authors and not necessarily those of the National Institutes of Health. Disclosures: NM has received unrestricted research grants and honoraria from Gilead and Merck.

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