In the United Kingdom, hepatitis C incidence rates among MSM and who are living with HIV dropped sharply after their peak in 2015, just before direct-acting antivirals (DAAs) became widely available through the country’s National Health Service (NHS), researchers reported in Clinical Infectious Diseases.
The retrospective cohort study at five urban HIV clinics found 378 acute HCV infections, 292 of which were first infections, between 2013 and 2018. The highest incidence rate, at 14.6/1,000 PYFU, was recorded in 2015. Incidence dropped to 4.6/1,000 PYFU in 2018. HCV reinfections appeared to hold relatively steady from the beginning to the end of the study period.
The study also found a dramatic scale-up of early HCV treatment initiation among the study population. In 2013, at the beginning of the study period (and prior to the regular availability of DAAs), the average gap between HCV diagnosis and treatment initiation was 30 months. By 2018, the gap had shrunk to four months.
In the UK, NHS rules do not allow for DAAs before six months of persistent viremia (among people with chronic infection) nor in case of reinfections, the authors of the current study noted. “Our data suggest that access to earlier public sector treatment than is currently available, including for reinfection, will remain important to ensure progress to microelimination targets in MSM living with HIV,” they concluded.