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Integrating hepatitis C testing and treatment into routine HIV care in Cameroon is feasible
Mathurin Pierre Kowo1, Liza Coyer2,3, Victor Sini4,5
1Research Laboratory on Viral Hepatitis and Health Communication, University of Yaoundé I, Yaoundé, Cameroon.
Insights
Hepatitis C virus (HCV) testing and treatment integrated into HIV care in Cameroon diagnosed new cases and achieved high cure rates. This strategy shows promise for HCV elimination, but access and capacity need improvement.
Area of Science:
- Infectious Diseases
- Hepatology
- Public Health
Background:
- Hepatitis C virus (HCV) infection poses greater risks for individuals with human immunodeficiency virus (HIV).
- HCV prevalence and access to diagnosis/treatment are poorly understood and limited for people with HIV in Cameroon.
- Integrating HCV services into routine HIV care could enhance diagnosis and treatment coverage.
Purpose of the Study:
- To determine the prevalence of HCV among people with HIV in Cameroon.
- To evaluate the treatment cure rate for HCV in this population.
- To assess the feasibility of integrating HCV services into existing HIV clinics.
Main Methods:
- HCV antibody and RNA testing offered to 8266 individuals aged ≥21 on HIV antiretroviral therapy (ART) with suppressed viral load.
- Positive HCV RNA cases received 12 weeks of sofosbuvir/velpatasvir treatment.
- Cure rate defined by sustained virological response 12 weeks post-treatment (SVR12).
Main Results:
- HCV antibody prevalence was 3.8% (316/8266), with 87.8% (251/286) having detectable HCV RNA.
- Of 173 enrolled, 165 completed treatment, achieving an SVR12 rate of 93.6%.
- Treatment completers showed a 98.2% SVR12 rate; all participants were eventually cured.
Conclusions:
- Integrating HCV testing and treatment into routine HIV care in Cameroon is viable.
- The study achieved high HCV cure rates, supporting its potential for HCV elimination.
- Improvements in testing uptake, access to diagnosis/treatment, and laboratory capacity are necessary for wider implementation.
Introduction:
Hepatitis C virus (HCV) prevalence and adverse outcomes are higher among people with human immunodeficiency virus (HIV) than people without HIV. Yet, HCV prevalence among people with HIV in Cameroon remains unknown, with HCV diagnosis and treatment largely inaccessible due to care centralization by specialists with high out-of-pocket costs. Integration of HCV services into routine HIV care by general practitioners could improve diagnosis and treatment coverage. We aimed to examine HCV prevalence and treatment cure rate among people with HIV attending 11 HIV clinics in the Centre Region of Cameroon.
Methods:
We offered HCV rapid antibody testing, and, if positive, RNA testing to all persons ≥21 years, on HIV ART for ≥6 months and with suppressed HIV RNA (<1000 copies) who attended HIV counselling and treatment appointments between 20 April 2021 and 31 May 2022. Participants with an HCV RNA positive test received 12 weeks of pangenotypic sofosbuvir/velpatasvir. We calculated the cure rate as the proportion of participants with a sustained virological response 12 weeks after treatment completion (SVR12) among all starting and completing treatment.
Results:
We tested 8266 persons for HCV antibodies, 316 (3.8%, 95% CI = 3.4-4.3%) of whom were anti-HCV positive. Of these, 286 (90.5%) were sampled for HCV RNA, 20 (6.3%) ineligible, 5 (1.6%) declined, 4 (1.3%) left before sampling and 1 (0.3%) had an unknown reason. Among 286 sampled, 251 (87.8%) had detectable HCV RNA. Of these, 173 (68.9%) enrolled for treatment, 55 (21.9%) were eligible but not enrolled (49 lost-to-follow-up, 6 denied) and 23 (9.2%) were ineligible. Of 173 enrolled, 165 completed treatment, 6 were lost-to-follow-up and 2 were excluded due to treatment interruption. SVR12 was achieved in 93.6% (n = 162; 95% CI: 88.9-96.8%) of those enrolled and 98.2% (95% CI: 94.8-99.6%) of treatment completers. All three initially not achieving SVR12 were cured with second-line treatment (sofosbuvir/velpatasvir/voxilaprevir).
Conclusions:
Our study demonstrates the viability of integrating HCV testing and treatment into routine HIV care in Cameroon, yielding new HCV diagnoses and high cure rates. Cameroon can use this strategy to achieve HCV elimination goals, although improvements in testing uptake, diagnosis and treatment access, and laboratory capacity are needed.
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