French Study Points to Eradication of HIV-HCV Coinfection

SEATTLE — The French are reporting that with optimal use of hepatitis C virus (HCV) direct-acting antiviral based treatments, it may be possible to nearly eradicate HIV-HCV coinfection in France within 10 years in most of risk groups. The researchers presented a mathematical model at CROI 2017 suggesting a new era in terms of these two coinfections.

The researchers reported that the prevalence of active HIV-HCV coinfection is expected to decrease to 1.1% in France over the next decade assuming HCV treatment coverage of 30%. They predict that acute infections and reinfections in high-risk men who have sex with men (MSM) and undiagnosed HIV-infected patients will account for the majority of infections in the future. 

The study points to focusing on care and greater outreach in specific patient populations in order to eradicate HIV-HCV coinfection. “The goal is to treat enough patients to have a diminishment of the reservoir of patients with active infection,” said study co-investigator Laurent Cotte, MD, who is an attending physician at Hospices Civils de Lyon in France.

He said if the United States adopted programs similar to that now in place in France, the United States could also eradicate new HIV-HCV infections.  “It can be adopted in other countries, if they have similar programs,” Dr Cotte said in an interview with Infectious Disease Advisor. “We have very few new infections with IV [intravenous] drug users because we have a syringe exchange program so there are few infections in IV drug users.” 

Lead study investigator Victor Virlogeux, MD, INSERM, Lyon, France, said France has the potential to eradicate new HIV-HCV infections because it has such a strong comprehensive healthcare system in place that involves continual patient care. “Compliance was good. They are already followed for their HIV infection. This is a good point of our study and why this works in France. They are under care and regularly followed by a physician. That may be why it works so well,” Dr Virlogeux said in an interview with Infectious Disease Advisor.

The researchers report that the widespread adoption of HCV direct-acting antiviral treatment among HIV-HCV coinfected patients in France resulted in HCV cure in more than half of patients at the end of 2015. The researchers used model projections to estimate the impact of HCV direct-acting antiviral treatment on HIV-HCV epidemiology over the next 10 years. For this model, they used data from the French DatAIDS cohort and divided patients into 8 risk groups.

The researchers estimated that on January 1, 2016, there were 156,811 patients infected with HIV in France and 131,861 were under care. Of these patients, 5.1% (7939 individuals) had an active HCV infection with a detectable serum RNA. The investigators assumed a treatment coverage (TC) of 30% a year, which was the observed rate in 2015.

Reference

Virlogeux V, Cotte L, Puglièse P, et al; DatAIDS Study Group. Modeling HIV-HCV epidemiology in the DAA era: the road to eradication. Presented at: CROI 2017. Seattle, WA; February 13-16, 2017. Abstract 135.