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Active and resolved HCV infections among people with new HIV-1 diagnoses in Germany, 2009-2019

Daniel Ivanusic1, Amare Eshetu1, Hussein Al-Shehabi1

  • 1Unit 18 HIV and Other Retroviruses/Sexually Transmitted Bacterial Pathogens (STI) and HIV, Department of Infectious Diseases, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany.

BMC Infectious Diseases
|November 5, 2025
PubMed

Insights

The introduction of direct-acting antivirals (DAAs) has increased the rate of resolved Hepatitis C Virus (HCV) infections in individuals newly diagnosed with Human Immunodeficiency Virus (HIV) in Germany. However, unmet needs persist, particularly for people who inject drugs and individuals of non-German origin.

Area of Science:

  • Infectious Diseases
  • Hepatology
  • Public Health

Background:

  • HIV and HCV share transmission routes, with co-infection accelerating liver disease progression.
  • Analysis of new HIV-1 diagnoses in Germany examines active or resolved HCV infection.
  • The study period coincides with the introduction of direct-acting antivirals (DAAs) for HCV treatment.

Purpose of the Study:

  • To assess the trends in active and resolved Hepatitis C Virus (HCV) infections among individuals newly diagnosed with Human Immunodeficiency Virus (HIV) in Germany.
  • To evaluate the impact of direct-acting antivirals (DAAs) on HCV treatment outcomes in this population.
  • To identify disparities in HCV infection and resolution rates among different demographic and transmission groups.

Main Methods:

  • Retrospective analysis of residual blood samples from 16,539 individuals with new HIV-1 diagnoses between 2009 and 2019.
  • Screening for HCV antigen and/or antibodies, followed by RT-qPCR for active or resolved infection.
  • Statistical analysis correlating HCV status with socio-demographic data and transmission routes.

Main Results:

  • Overall HCV seroprevalence was 6.2%, with a stable trend.
  • The proportion of resolved HCV infections significantly increased post-DAA introduction (from 33.0% to 48.2% by 2019).
  • People who inject drugs (PWIDs) showed the highest prevalence (73.7%) but the lowest resolution rate (29.4%).
  • Individuals of non-German origin had higher active/resolved case proportions (8.8% vs. 4.3%) and lower resolution rates (27.8% vs. 34.0%) compared to German-born individuals.

Conclusions:

  • The proportion of resolved HCV infections has risen following DAA implementation in Germany.
  • Significant unmet diagnostic and therapeutic needs for HCV exist among PWIDs.
  • Higher active/resolved HCV case proportions and lower resolution rates in individuals of non-German origin warrant targeted public health interventions.
Abstract

Keywords:
Hepatitis C Virus (HCV)Human Immunodeficiency Virus (HIV)Men who have Sex with Men (MSM)People Who Inject Drugs (PWID)

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