Access to Direct-Acting Antivirals And Incidence of Hepatitis C - EMJ

Does Access to Direct-Acting Antivirals Reduce Incidence of Hepatitis C?

2 Mins
Hepatology

NEW data showed that by improving access to direct-acting antivirals (DAA), the incidence rate of hepatitis C virus (HCV) can be reduced in people with HIV through a treatment as prevention effect, particularly among people with high-risk behaviours.

The study involved assessment of changes in primary HCV incidence in patients with HIV following access to DAAs, using data from the Internal Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC). The authors believe that monitoring and validating HCV elimination is highly feasible in patients with HIV in high-income countries, through surveillance systems and accessible, affordable, high-quality healthcare.

The data showed that out of 101,045 patients, 74% had a negative HCV antibody result, and 69% of those had a subsequent test to calculate follow-up. The authors then limited the cohort to include 45,942 participants. Follow-up ended after the last negative antibody test or estimated infection, between 2010–2019. Results showed 2,042 HCV infections over 248,189 person-years, and the incidence rate declined from 0.91 per person-years in 2015 to 0.41 per 100 person-years in 2019.

The authors noted a strong decline in HCV incidence in the first few years following access to DAAs, which slowed over time. It is unclear whether this trend continued after the study ended; however, since the start of the COVID-19 pandemic in 2020, there has been a decrease in HCV testing and diagnosis.

The average incidence was similar during the period of access to limited DAAs compared to the incidence before the DAA period; however, it led to a 9% annual decline in incidence. The average incidence was 52% lower during the period of access to broad DAAs, and there was a further 20% annual decline in incidence. The authors concluded that broad DAA access has an effect on the incidence of HCV in people with HIV, and that countries in the InCHEHC collaboration can meet the World Health Organization (WHO)’s target of reducing HCV incidence by 80% by 2030.

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