HCV incidence in people with HIV in southwest China: A retrospective cohort study (2004-2023)

Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections are global public health concerns. Little research has been conducted on HCV incidence in people with HIV (PWH).

This was a retrospective cohort study to investigate HCV incidence and associated factors in PWH. HCV-negative PWH registered in national HIV databases were enrolled and followed up from 2004 to 2023. Cox proportional hazards models were utilized to identify factors associated with HCV infections.

The study followed 50 245 HCV-negative PWH, totaling 272 979.3 person-years (PYs) of observation. We noted an HCV incidence rate of 0.70 per 100 PYs (95% confidence interval (CI) 0.67-0.73). Multivariate analysis indicated that being female (adjusted hazard ratio [aHR] 0.70), married (aHR 0.88), and those involved in homosexual intercourse (aHR 0.57) were associated with a lower risk of HCV infection. Conversely, an increased risk was found among those aged 20-39 years (aHR 2.97), 40-59 years (aHR 3.11), ≥ 60 years (aHR 1.80), treated at county-level antiretroviral therapy (ART) clinics (aHR 1.19), township-level ART clinics (aHR 1.83), those with a history of intravenous drug use (aHR 21.72), and individuals without CD4 testing (aHR 66.05) or HIV viral load testing (aHR 2.09). A 36% relative reduction in HCV transmission (aHR 0.64) was observed from 2010 to 2015, and a 29% relative reduction (aHR 0.71) was noted after 2016 compared with the pre-2010 levels.

Despite the decrease in HCV incidence after 2010, achieving HCV elimination in PWH remains challenging. Future endeavours should prioritize improving HCV testing, intervention, and treatment in PWH.