Establishing a framework towards monitoring HCV microelimination among men who have sex with men living with HIV in Germany: A modeling analysis

Background Prior to direct-acting antivirals (DAAs), HCV incidence rose among men who have sex with men (MSM) living with HIV infection in Germany despite high hepatitis C virus (HCV) treatment rates. We establish a HCV elimination modeling framework to evaluate whether existing treatment rates can achieve the World Health Organization (WHO) incidence target among MSM living with HIV in Germany. Methods To evaluate progress towards HCV elimination in Germany, we adapted a previously published HCV transmission model among MSM living with diagnosed HIV. We modelled HCV incidence and prevalence until 2030 (relative to 2015) under existing treatment and DAA scale-up and explored potential impacts of disruptions in treatment and behavioral risk reduction due to the COVID-19 pandemic. Results Continuing current treatment rates will result in stable HCV incidence among MSM living with HIV in Germany between 2015–2030. The WHO HCV incidence target is achievable under DAA scale-up to 100% treatment combined with treatment of those previously diagnosed and untreated (at a rate of 15%/year) and would result in greater reductions with early treatment (3 vs 6 months) reducing incidence from 4.0/100person-years to 0.8/100person-years by 2030. A 12-month disruption to HCV treatment (20% reduction) and risk behaviors (25%,50%,75% reduction) during the COVID-19 pandemic would result in a 15% relative increase in total HCV incidence in 2030 compared to that expected under the status quo. Conclusions HCV elimination among MSM living with HIV in Germany requires further DAA scale-up among those newly diagnosed combined with efforts to treat those previously diagnosed but untreated. Prospective monitoring will establish whether Germany is on track for HCV microelimination.

[1]  T. Antoniou,et al.  Global Utilization Trends of Direct Acting Antivirals (DAAs) during the COVID-19 Pandemic: A Time Series Analysis , 2021, Viruses.

[2]  G. Whitlock,et al.  COVID-19 restrictions and changing sexual behaviours in HIV-negative MSM at high risk of HIV infection in London, UK , 2021, Sexually Transmitted Infections.

[3]  T. Kurth,et al.  Everything counts - a method to determine viral suppression among people living with HIV using longitudinal data for the HIV care continuum - results of two large, German, multi-center real-life cohort studies over 20 years (1999–2018) , 2020, BMC Public Health.

[4]  N. Luhmann,et al.  Prevalence and incidence of hepatitis C virus infection in men who have sex with men: a systematic review and meta-analysis. , 2020, The lancet. Gastroenterology & hepatology.

[5]  E. Wouters,et al.  Reduced sexual contacts with non-steady partners and less PrEP use among MSM in Belgium during the first weeks of the COVID-19 lockdown: results of an online survey , 2020, Sexually Transmitted Infections.

[6]  L. Degenhardt,et al.  Substantial Decline in Use of HIV Preexposure Prophylaxis Following Introduction of COVID-19 Physical Distancing Restrictions in Australia: Results From a Prospective Observational Study of Gay and Bisexual Men , 2020, Journal of acquired immune deficiency syndromes.

[7]  F. Wood,et al.  Early impact of COVID-19 social distancing measures on reported sexual behaviour of HIV pre-exposure prophylaxis users in Wales , 2020, Sexually Transmitted Infections.

[8]  L. Degenhardt,et al.  Physical distancing due to COVID-19 disrupts sexual behaviours among gay and bisexual men in Australia: Implications for trends in HIV and other sexually transmissible infections. , 2020, Journal of acquired immune deficiency syndromes.

[9]  G. Cooke,et al.  Decline in Hepatitis C Virus (HCV) Incidence in Men Who Have Sex With Men Living With Human Immunodeficiency Virus: Progress to HCV Microelimination in the United Kingdom? , 2020, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[10]  S. Mauss,et al.  Reinfection with the hepatitis C virus in men who have sex with men after successful treatment with direct-acting antivirals in Germany: Current incidence rates compared with rates during the interferon era. , 2020, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[11]  J. Rockstroh,et al.  Can HCV be eliminated among HIV-positive men who have sex with men in Berlin? A modeling analysis. , 2019, The Journal of infectious diseases.

[12]  D. Schmidt,et al.  Schätzung der Zahl der HIV-Neuinfektionen und der Gesamtzahl von Menschen mit HIV in Deutschland , 2018 .

[13]  C. Boucher,et al.  Declining Hepatitis C Virus (HCV) Incidence in Dutch Human Immunodeficiency Virus-Positive Men Who Have Sex With Men After Unrestricted Access to HCV Therapy , 2018, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[14]  David P. Wilson,et al.  Eliminating hepatitis C virus as a public health threat among HIV‐positive men who have sex with men: a multi‐modelling approach to understand differences in sexual risk behaviour , 2018, Journal of the International AIDS Society.

[15]  A. d’Arminio Monforte,et al.  Lack of decline in hepatitis C virus incidence among HIV-positive men who have sex with men during 1990-2014. , 2017, Journal of hepatology.

[16]  I. Krznaric,et al.  HIV‐positive men who have sex with men are at high risk of development of significant liver fibrosis after an episode of acute hepatitis C , 2017, Journal of viral hepatitis.

[17]  D. Schadendorf,et al.  Sexual risk behavior, sexually transmitted infections, and HIV transmission risks in HIV‐positive men who have sex with men (MSM) – approaches for medical prevention , 2017, Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG.

[18]  H. Stellbrink,et al.  HCV reinfection incidence and spontaneous clearance rates in HIV-positive men who have sex with men in Western Europe. , 2017, Journal of hepatology.

[19]  A. Schmidt,et al.  Illicit drug use among gay and bisexual men in 44 cities: Findings from the European MSM Internet Survey (EMIS). , 2016, The International journal on drug policy.

[20]  D. Dieterich,et al.  Management of Hepatitis C/HIV Coinfection in the Era of Highly Effective Hepatitis C Virus Direct-Acting Antiviral Therapy. , 2016, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[21]  C. Sabin,et al.  Can Hepatitis C Virus (HCV) Direct-Acting Antiviral Treatment as Prevention Reverse the HCV Epidemic Among Men Who Have Sex With Men in the United Kingdom? Epidemiological and Modeling Insights , 2016, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[22]  H. Stellbrink,et al.  Dual treatment of acute HCV infection in HIV co-infection: influence of HCV genotype upon treatment outcome , 2016, Infection.

[23]  H. Jessen,et al.  High Prevalence and High Incidence of Coinfection with Hepatitis B, Hepatitis C, and Syphilis and Low Rate of Effective Vaccination against Hepatitis B in HIV-Positive Men Who Have Sex with Men with Known Date of HIV Seroconversion in Germany , 2015, PloS one.

[24]  Robert Koch-Institut Schätzung der Prävalenz und Inzidenz von HIV-Infektionen in Deutschland, Stand Ende 2014 , 2015 .

[25]  Kholoud Porter,et al.  Impact on life expectancy of HIV-1 positive individuals of CD4+ cell count and viral load response to antiretroviral therapy , 2014, AIDS.

[26]  C. Sabin,et al.  Effect of HCV infection on cause-specific mortality after HIV seroconversion, before and after 1997. , 2013, Gastroenterology.

[27]  N. Ford,et al.  Treatment Outcomes of Treatment-Naïve Hepatitis C Patients Co-Infected with HIV: A Systematic Review and Meta-Analysis of Observational Cohorts , 2013, PloS one.

[28]  H. Günthard,et al.  Hepatitis C virus infections in the Swiss HIV Cohort Study: a rapidly evolving epidemic. , 2012, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[29]  N. Pai,et al.  Incidence of acute hepatitis C virus infection among men who have sex with men with and without HIV infection: a systematic review , 2012, Sexually Transmitted Infections.

[30]  Andrew N. Phillips,et al.  Projected life expectancy of people with HIV according to timing of diagnosis , 2012, AIDS.

[31]  Accessed from , 2012 .

[32]  B. Gazzard,et al.  Impact of late diagnosis and treatment on life expectancy in people with HIV-1: UK Collaborative HIV Cohort (UK CHIC) Study , 2011, BMJ : British Medical Journal.

[33]  Atlanta,et al.  Sexual transmission of hepatitis C virus among HIV-infected men who have sex with men--New York City, 2005-2010. , 2011, MMWR. Morbidity and mortality weekly report.

[34]  Joseph Eliahoo,et al.  Predicting spontaneous clearance of acute hepatitis C virus in a large cohort of HIV-1-infected men , 2010, Gut.

[35]  S. Pol,et al.  Treatment of acute hepatitis C in human immunodeficiency virus–infected patients: The HEPAIG study , 2010, Hepatology.

[36]  Martin Fisher,et al.  Evidence of a large, international network of HCV transmission in HIV-positive men who have sex with men. , 2009, Gastroenterology.

[37]  David Welch,et al.  Approximate Bayesian computation scheme for parameter inference and model selection in dynamical systems , 2009, Journal of The Royal Society Interface.

[38]  Qilong Yi,et al.  Natural history of hepatitis C virus infection in HIV-infected individuals and the impact of HIV in the era of highly active antiretroviral therapy: a meta-analysis , 2008, AIDS.

[39]  Anne M Johnson,et al.  Recent epidemic of acute hepatitis C virus in HIV-positive men who have sex with men linked to high-risk sexual behaviours , 2007, AIDS.

[40]  O. Kirk,et al.  Liver-related deaths in persons infected with the human immunodeficiency virus: the D:A:D study. , 2006, Archives of internal medicine.