Recently acquired hepatitis C virus infection in people with HIV - what have we learned?

Early treatment of recently acquired HCV infections (RAHCV) in people with HIV (PWH) can be of particular importance for both individual and public health. Since the introduction of direct acting antivirals (DAA), guideline recommendations have shifted from waiting/ re-testing approaches towards immediate treatment. Until recently, however, the fact that no DAA regimen had regulatory approval for the treatment of acute HCV infection represented an obstacle to early treatment. This review aims to summarize lessons learned on RAHCV in PWH.

A phase 3b trial has recently supported safety and efficacy of glecaprevir/ pibrentasvir (G/P) for the treatment of RAHCV in PWH, which led to the approval of that regimen for acute hepatitis C by the U.S. Food and Drug administration. Studies evaluating shorter durations of common pangenotypic regimens for RAHCV showed mixed results. Despite some positive developments, like a steep decline of HCV infections in men who have sex with men (MSM) living with HIV in Europe or Australia, current efforts are not sufficient to meet WHO targets.

Treatment of RAHCV, especially among key populations living with HIV, is a cornerstone of HCV elimination attempts. Recent studies might help reinvigorate these efforts.