Search

Background: Following the introduction of direct-acting antiviral therapy in 2013, WHOlaunched the first Global Health Sector Strategy on Viral Hepatitis. We describe a hepatitis C virus (HCV) cascade of care in people with HIV (PWH) across Europe in terms of reaching the WHO elimination targets of diagnosing 90% and treating 80% of HCV-infected individuals. Methods: HIV/HCV-coinfected participants in the EuroSIDA cohort under prospective follow-up at October 1, 2019, were described using a nine-stage cascade of care. Care cascades were constructed across Europe, on a regional (n 5) and country (n 21) level. Results: Of 4773 anti-HCV positive PWH, 4446 [93.1%, 95% confidence interval (CI) 92.4-93.9)] were ever tested for HCV RNA, and 19.0% (95% CI 16.4-21.6) were currently HCV RNA positive, with the highest prevalence in Eastern and Central-Eastern Europe (33.7 and 29.6%, respectively). In Eastern Europe, 78.1% of the estimated number of chronic infections have been diagnosed, whereas this proportion was above 95% in the other four regions. Overall, 3116 persons have ever started treatment (72.5% of the ever chronically infected, 95% CI 70.9-74.0) and 2404 individuals (55.9% of the ever chronically infected, 95% CI 53.9-57.9) were cured. Cure proportion ranged from 11.2% in Belarus to 87.2% in Austria. Conclusion: In all regions except Eastern Europe, more than 90% of the study participants have been tested for HCV-RNA. In Southern and Central-Western regions, more than 80% ever chronically HCV-infected PWH received treatment. The proportion with cured HCV infection did not exceed 80% in any region, with significant heterogeneity between countries. Summary: In a pan-European cohort of PWH, all regions except Eastern Europe achieved the WHO target of diagnosing 90% of chronic HCV infections, while the target of treating 80% of eligible persons was achieved in none of the five regions.

Background and aims: To investigate the uptake of hepatitisCvirus (HCV) therapy among HIV/HCV-coinfectedpatients inthepan-EuropeanEuroSIDAstudybetween2011and2016. Methods: All HCV-RNA patients were included. Baseline was defined as latest of anti-HCV , January 2011 or enrolment in EuroSIDA. The incidence of starting first interferon-free direct-Acting antiviral (DAA) therapy was calculated. Factors associated with starting interferon-free DAA were determined by Poisson regression. Results: Among 4308HCV-RNA patients (1255, 970, 663, 633, 787 fromSouth,West, North, Central East and East Europe, respectively) with 11 863 person-years of follow-up, 1113(25.8%)started anyHCVtherapy.Among patients with at least F3 fibrosis,more than 50% in all regions remained untreated. The incidence (per 1000 person-years of followup, 95% confidence interval) of starting DAA increased from 7.8 (5.9 9.8) in 2014 to 135.2 (122.0 148.5) in 2015 and 128.9 (113.5 144.3) in 2016. The increase was highest in North and West and intermediate in South, but remained modest in Central East and Eastern Europe. After adjustment, women, individuals fromCentral East or East, genotype 3, antiretroviral therapy nai ve and those with detectable HIV-RNAwere less likely to start DAA. Older persons, those withHCV-RNAmore than 500 000 IU/ml and those withmore advanced liver fibrosis were more likely to start DAA. Conclusion: Uptake of DAA therapy among HIV/HCV-coinfected patients increased considerably in Western Europe between 2014 and 2016, but was modest in Central East and East. In all regions more than 50% with at least F3 fibrosis remained untreated. Women were less likely to start DAA. © 2018 Lippincott Williams and Wilkins. All rights reserved.