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HCV Cascade of Care in HIV/HCV Co-Infected Individuals: Missed Opportunities for Micro-Elimination

Christos Thomadakis1, Dimitrios Basoulis2, Olga Tsachouridou3

  • 1Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece.

Viruses
|June 27, 2024
PubMed

Insights

This study tracked Hepatitis C care for people with HIV-HCV co-infection in Greece. Significant gaps and disparities in care persist, especially for migrants and people who inject drugs, impacting treatment outcomes.

Area of Science:

  • Infectious Diseases
  • Public Health
  • Hepatology

Background:

  • People with HIV-HCV co-infection are a key group for Hepatitis C virus (HCV) micro-elimination efforts.
  • Understanding the HCV cascade of care (CoC) is crucial for improving outcomes in this vulnerable population.
  • Greece's HIV-HCV co-infected population presents unique challenges and opportunities for HCV elimination.

Purpose of the Study:

  • To analyze the HCV cascade of care (CoC) among HIV-HCV co-infected individuals in Greece.
  • To identify factors influencing progression through each stage of the HCV care continuum.
  • To assess disparities in HCV care and treatment outcomes across different subgroups.

Main Methods:

  • Analysis of data from 1213 participants in the Athens Multicenter AIDS Cohort Study.
  • Construction of a seven-stage HCV CoC, from diagnosis to sustained virologic response (SVR).
  • Application of logistic and Cox regression models to identify factors associated with CoC progression.

Main Results:

  • Mortality before direct-acting antiviral (DAA) availability was 9.2%, with higher rates among people who inject drugs (PWID).
  • Retention in care and HCV-RNA testing rates were lower for migrants and PWID.
  • While 71% initiated DAAs, very low CD4 counts (<100 cells/μL) were linked to lower initiation odds; SVR rates were high (85.7%) and consistent across groups.

Conclusions:

  • Significant gaps and between-group differences persist in the HCV CoC for HIV-HCV co-infected individuals in Greece as of 2023.
  • Targeted interventions are needed to improve care access and outcomes for marginalized subgroups, including migrants and PWID.
  • Despite challenges, high SVR rates post-DAA treatment indicate the potential for HCV elimination with optimized care pathways.

Keywords:
DAAsHCV micro-eliminationHIV/HCV co-infectioncascade of care (COC)missed opportunities

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