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Abstract
Objective Since the early 2000s, there has been an epidemic of HCV occurring among men who have sex with men (MSM) living with HIV, mainly associated with high-risk sexual and drug-related behaviours. Early HCV diagnosis and treatment, and behavioural risk-reduction, may be effective to eliminate HCV among MSM living with HIV.
Design We developed a deterministic dynamic compartmental model to simulate the impact of test-and-treat and risk-reduction strategies on HCV epidemic (particularly on incidence and prevalence) among MSM living with HIV in France. We accounted for HIV and HCV cascades of care, HCV natural history and heterogeneity in HCV risk behaviours. The model was calibrated to primary HCV incidence observed between 2014 and 2017 among MSM living with HIV in care (ANRS CO4-French hospital database on HIV (FHDH)).
Results With current French practices (annual HCV screening and immediate treatment), total HCV incidence would fall by 70%, from 0.82/100 person-years in 2015 to 0.24/100 person-years in 2030. It would decrease to 0.19/100 person-years in 2030 with more frequent screening and to 0.19 (0.12)/100 person-years in 2030 with a 20% (50%) risk-reduction. When combining screening every 3 months with a 50% risk-reduction, HCV incidence would be 0.11/100 person-years in 2030, allowing to get close to the WHO target (90% reduction from 2015 to 2030). Similarly, HCV prevalence would decrease from 2.79% in 2015 to 0.48% in 2030 (vs 0.71% with current practices).
Conclusion Combining test-and-treat and risk-reduction strategies could have a marked impact on the HCV epidemic, paving the way to HCV elimination among MSM living with HIV.
- HCV
- decision analysis
- HIV/AIDS
- antiviral therapy
- chronic hepatitis
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
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Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
Footnotes
Contributors MC: study concept and design; methodology; acquisition of data; formal analysis and interpretation of results; drafting of the manuscript; critical revision of the manuscript for important intellectual content; obtained funding; approved final submission. AC: study concept and design; methodology; interpretation of results; drafting of the manuscript; critical revision of the manuscript for important intellectual content; study supervision; obtained funding; approved final submission. VS: interpretation of results; critical revision of the manuscript for important intellectual content; approved final submission. AV: acquisition of data; interpretation of results; critical revision of the manuscript for important intellectual content; approved final submission. JG: interpretation of results; critical revision of the manuscript for important intellectual content; approved final submission. ADP: methodology; interpretation of results; critical revision of the manuscript for important intellectual content; approved final submission. YY: study concept and design; methodology; interpretation of results; critical revision of the manuscript for important intellectual content; study supervision; approved final submission. SD-B: study concept and design; methodology; interpretation of results; drafting of the manuscript; critical revision of the manuscript for important intellectual content; study supervision; obtained funding; approved final submission. All authors have been involved in revising the content of this work, approved the final manuscript, and agree to be accountable for all aspects of the work. All authors have approved the final version of the manuscript.
Funding This work was supported by the French Agency for Research on AIDS and Viral Hepatitis (ANRS), grant number 95031.
Competing interests VS has served on advisory boards for ViiV Healthcare (2016) and Gilead (2018) and reports lecture fees from Gilead (2017, 2019 and 2020), Janssen (2018 and 2020) and ViiV (2019), AbbVie (2018), outside the submitted work. SD-B has received consultancy honoraria from Intercept.
Provenance and peer review Not commissioned; externally peer-reviewed.
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