30 research outputs found
Hepatitis C Infection in Dutch HIV-Positive Patients in the Era of Direct-Acting Antiviral Therapy
Is hepatitis C virus elimination possible among people living with HIV and what will it take to achieve it?
Introduction
The World Health Organization targets for hepatitis C virus (HCV) elimination include a 90% reduction in new infections by 2030. Our objective is to review the modelling evidence and cost data surrounding feasibility of HCV elimination among people living with HIV (PLWH), and identify likely components for elimination. We also discuss the realâworld experience of HCV direct acting antiviral (DAA) scaleâup and elimination efforts in the Netherlands.
Methods
We review modelling evidence of what intervention scaleâup is required to achieve WHO HCV elimination targets among HIVâinfected (HIV+) people who inject drugs (PWID) and men who have sex with men (MSM), review costâeffectiveness of HCV therapy among PLWH and discuss economic implications of elimination. We additionally use the realâworld experience of DAA scaleâup in the Netherlands to illustrate the promise and potential challenges of HCV elimination strategies in MSM. Finally, we summarize key components of the HCV elimination response among PWLH.
Results and discussion
Modelling indicates HCV elimination among HIV+ MSM and PWID is potentially achievable but requires combination treatment and either harm reduction or behavioural risk reductions. Preliminary modelling indicates elimination among HIV+ PWID will require elimination efforts among PWID more broadly. Treatment for PLWH and highârisk populations (PWID and MSM) is costâeffective in highâincome countries, but costs of DAAs remain a barrier to scaleâup worldwide despite the potential low production price ($50 per 12 week course). In the Netherlands, universal DAA availability led to rapid uptake among HIV+ MSM in 2015/16, and a 50% reduction in acute HCV incidence among HIV+ MSM from 2014 to 2016 was observed. In addition to HCV treatment, elimination among PLWH globally also likely requires regular HCV testing, development of lowâcost accurate HCV diagnostics, reduced costs of DAA therapy, broad treatment access without restrictions, close monitoring for HCV reinfection and retreatment, and harm reduction and/or behavioural interventions.
Conclusions
Achieving WHO HCV Elimination targets is potentially achievable among HIVâinfected populations. Among HIV+ PWID, it likely requires HCV treatment scaleâup combined with harm reduction fo
First reported case of an ectopic renal giant worm (Dioctophyme renale) infection in the abdominal cavity
Transmission of NS5A-Inhibitor Resistance-Associated Substitutions among Men Who Have Sex with Men Recently Infected with Hepatitis C Virus Genotype 1a
The transmission of direct-acting antiviral resistance-associated substitutions (RAS) could hamper hepatitis C virus (HCV) cure rates and elimination efforts. A phylogenetic analysis of 87 men who have sex with men recently infected with HCV genotype 1a placed one-third (28/87) in a large cluster, in which 96% harbored NS5A M28V RAS.</p
Transmission of NS5A-Inhibitor Resistance-Associated Substitutions among Men Who Have Sex with Men Recently Infected with Hepatitis C Virus Genotype 1a
Declining Hepatitis C Virus (HCV) Incidence in Dutch Human Immunodeficiency Virus-Positive Men Who Have Sex With Men After Unrestricted Access to HCV Therapy
Background
Direct-acting antivirals (DAAa) cure hepatitis C virus (HCV) infections in 95% of infected patients. Modeling studies predict that universal HCV treatment will lead to a decrease in the incidence of new infections but real-life data are lacking. The incidence of HCV among Dutch human immunodeficiency virus (HIV)âpositive men who have sex with men (MSM) has been high for >10 years. In 2015 DAAs became available to all Dutch HCV patients and resulted in a rapid treatment uptake in HIV-positive MSM. We assessed whether this uptake was followed by a decrease in the incidence of HCV infections.
Methods
Two prospective studies of treatment for acute HCV infection enrolled patients in 17 Dutch HIV centers, having 76% of the total HIV-positive MSM population in care in the Netherlands. Patients were recru