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Hepatitis C virus-microelimination program and patient trajectories after hepatitis C virus cure in an outpatient HIV
Caroline Lions1, Helene Laroche1, Olivia Zaegel-Faucher1
1APHM, Hopital Sainte-Marguerite, Service d'Immuno-Hématologie Clinique.
Insights
A hepatitis C (HCV) microelimination program in an HIV clinic showed feasibility but did not achieve eradication in 12 months. HCV cure positively impacted patient health outcomes, demonstrating the value of integrated care models.
Area of Science:
- Hepatology
- Infectious Diseases
- Public Health
Background:
- Current hepatitis C (HCV) treatment guidelines do not differentiate between HIV/HCV-coinfected and HCV-monoinfected patients.
- A significant challenge in managing HIV-positive individuals is the lack of effective models for HCV elimination.
- Microelimination strategies are being explored to eradicate infectious diseases within specific populations or settings.
Purpose of the Study:
- To evaluate the feasibility of a 12-month HCV microelimination program in an HIV outpatient clinical unit.
- To assess the possibility of eradicating HCV among people living with HIV within a defined clinical setting.
- To investigate the impact of HCV cure on various health outcomes in coinfected patients.
Main Methods:
- A prospective HCV microelimination program was implemented in an HIV clinic serving approximately 1000 patients.
- The program integrated screening and direct-acting antiviral (DAA) treatment components.
- A nested cohort study used questionnaires and statistical models to evaluate the impact of HCV cure on health.
Main Results:
- The program diagnosed two new HCV acute infections and one reinfection among evaluated patients.
- Of eligible patients, 46.4% initiated DAA treatment within 12 months, with 31.8% initiating after.
- A high sustained virologic response (SVR) rate of 96.1% was achieved, with positive impacts on physical and mental health reported.
Conclusions:
- The HCV microelimination program demonstrated feasibility at the scale of an HIV clinical unit.
- Achieving complete HCV eradication within 12 months was not met, highlighting the need for longer-term strategies.
- The study serves as a proof of concept for integrated HCV elimination efforts within HIV care settings.
Objective:
Treatment recommendations for hepatitis C now make no distinction between HIV/HCV-coinfected and HCV-monoinfected patients. The largest challenge remained lack of effective models to eliminate HCV in people living with HIV. We report the results of a microelimination program evaluating the possibility of eradicating HCV in an HIV-outpatient clinical unit within 12 months.
Methods:
This HCV-microelimination program began in February 2016 in an unit following approximately 1000 HIV-infected patients and combined screening and therapeutic components according to the French guideline. A nested cohort study evaluating the impact of HCV cure on different health outcomes was conducted through self-administered questionnaires and using generalized mixed models.
Results:
Among 601 patients eligible for HCV serological testing, 445 were evaluated, and two HCV acute infections were diagnosed. Among the 151 patients eligible for HCV RNA quantification, 119 were evaluated, and one reinfection with HCV was diagnosed. Among the 110 patients eligible for direct-acting antiviral treatment, 51 (46.4%) initiated treatment within the 12 months program, and 35 (31.8%) after. Sustained virologic response (SVR) rate was 96.1%, and two treatments failed. At least one self-reported symptom was declared by 72.5% (n = 29) of patients. Positive impact of HCV cure was observed on various markers of physical and mental health as well as on health habits.
Conclusion:
Our program should be considered as a proof of concept, which confirmed the feasibility of a HCV-microelimination program at the scale of an HIV clinical unit. However, 12 months were not sufficient to achieve our objective despite the specific organization.
