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4CPS-266 Analysis of an epidemiological model for the treatment of hepatitis C virus in co-infected HIV/HCV drug addictions via parenteral
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4CPS-266 Analysis of an epidemiological model for the treatment of hepatitis C virus in co-infected HIV/HCV drug addictions via parenteral
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4CPS-266 Analysis of an epidemiological model for the treatment of hepatitis C virus in co-infected HIV/HCV drug addictions via parenteral
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Journal Article
4CPS-266 Analysis of an epidemiological model for the treatment of hepatitis C virus in co-infected HIV/HCV drug addictions via parenteral
2019
Overview
BackgroundThe scale-up of HCV treatment for HIV/HCV coinfected individuals is occurring, the majority with a history of injecting drug use.PurposeWe assess the implications for achieving the World Health Organisation HCV incidence elimination target (80% reduction from 2015–2030) among HIV-infected (HIV+) people who inject drugs (PWID) and all PWID, using dynamic modelling.Material and methodsA joint HIV and HCV transmission model among PWID was based on published data and the HERACLES cohort (prospective cohort of HIV/HCV coinfected individuals in care from 2015–2017). The model was stratified by HIV stage, HCV stage and PWID status (young PWID (<10 years’ injecting), old PWID (>10 years’ injecting), ex PWID). We simulated: 45%/60% chronic HCV prevalence and 20%/40% HIV prevalence among PWID injecting for <10 years and >10 years, respectively, 54% chronic HCV among HIV +ever PWID (PWID +ex PWID). We assumed HCV treatment among diagnosed coinfected ever-PWID of 10.5%/year from 2004–2014, and 33%/year from 2015 (from HERACLES). We projected the impact of current treatment, and scaled-up treatment (among HIV +PWID or all PWID) from 2018 on HCV prevalence/incidence among HIV +PWID and all PWID.ResultsWe projected that 28% and 32% of HCV +PWID and HCV +ex PWID, respectively, were HIV/HCV coinfected in 2015. Current treatment rates could reduce the number of diagnosed coinfected PWID by 75% from 2015–2030. However, this would only reduce HCV incidence by a relative 25% and 16% among HIV +PWID and all PWID, respectively. If all coinfected PWID were diagnosed and treated annually from 2018, this could reduce chronic HCV prevalence by 74% among HIV+ PWID by 2030, but only halve the incidence. Greater impact could be achieved through scaling-up treatment to all PWID.ConclusionHCV elimination among HIV +PWID will not be achieved by treating coinfected PWID alone: efforts should focus on HCV diagnosis and treatment among both coinfected and monoinfected PWID. Scaling-up treatment to all PWID.References and/or acknowledgementsNo conflict of interest.
Publisher
BMJ Publishing Group LTD
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