HCV micro-elimination in individuals with HIV in the Netherlands 4 years after universal access to direct-acting antivirals: a retrospective cohort study

ATHENA observational cohort

doi:10.1016/S2352-3018(20)30301-5

HCV micro-elimination in individuals with HIV in the Netherlands 4 years after universal access to direct-acting antivirals: a retrospective cohort study

ATHENA observational cohort

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: In the Netherlands, access to direct-acting antivirals (DAAs) against hepatitis C virus (HCV) has been unrestricted for chronic infection since 2015. We evaluated whether the nationwide incidence of HCV infections in individuals with HIV has changed since 2015. Methods: In this retrospective cohort study, data from the ATHENA cohort of people with HIV aged 18 years or older attending any of the 24 HIV treatment centres in the Netherlands between 2000 and 2019 were assessed. We used parametric proportional hazards models with a piecewise exponential survival function to model HCV primary infection and reinfection incidence per 1000 person-years. Findings: Of the 23 590 individuals without previous HCV infection, 1269 cases of HCV primary infection were documented (incidence 5·2 per 1000 person-years [95% CI 5·0–5·5]). The highest incidence was observed in men who have sex with men (MSM; 7·7 per 1000 person-years [7·3–8·2]) and was lower in people who inject drugs (PWID; 1·7 per 1000 person-years [0·7–4·1]) and other key populations (1·0 per 1000 person-years [0·8–1·2]). In MSM, incidence increased in 2007 to 14·3 per 1000 person-years and fluctuated between 8·7 and 13·0 per 1000 person-years from 2008 to 2015. In 2016, incidence declined to 6·1 cases per 1000 person-years and remained steady between 4·1 and 4·9 per 1000 person-years from 2017 to 2019. Of the 1866 individuals with a previous HCV infection, 274 reinfections were documented (incidence 26·9 per 1000 person-years [95% CI 23·9–30·3]). The highest incidence rate was observed in MSM (38·5 per 1000 person-years [33·9–43·7]) and was lower in PWID (10·9 per 1000 person-years [3·5–33·8]) and other key populations (8·9 per 1000 person-years [6·3–12·5]). In MSM, reinfection incidence fluctuated between 38·0 and 88·9 per 1000 person-years from 2006 to 2015, reaching 55·6 per 1000 person-years in 2015. In 2016, reinfection incidence declined to 41·4 per 1000 person-years, followed by further decreases to 24·4 per 1000 person-years in 2017 and 11·4 per 1000 person-years in 2019. Interpretation: The sharp decline in HCV incidence in MSM with HIV shortly after restrictions on DAAs were lifted suggests a treatment-as-prevention effect. HCV incidence was already low in PWID and other groups before unrestricted access. Ongoing HCV transmission is occurring in MSM, as illustrated by a declining but high rate of reinfection, stressing the need for additional preventive measures. Funding: Dutch Ministry of Health, Welfare, and Sport.

Original language	English
Pages (from-to)	e96-e105
Journal	The Lancet HIV
Volume	8
Issue number	2
DOIs	https://doi.org/10.1016/S2352-3018(20)30301-5
Publication status	Published - Feb 2021

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10.1016/S2352-3018(20)30301-5

Cite this

@article{0714c7c3fa7d40109bcbe3356d3c47f2,

title = "HCV micro-elimination in individuals with HIV in the Netherlands 4 years after universal access to direct-acting antivirals: a retrospective cohort study",

abstract = "Background: In the Netherlands, access to direct-acting antivirals (DAAs) against hepatitis C virus (HCV) has been unrestricted for chronic infection since 2015. We evaluated whether the nationwide incidence of HCV infections in individuals with HIV has changed since 2015. Methods: In this retrospective cohort study, data from the ATHENA cohort of people with HIV aged 18 years or older attending any of the 24 HIV treatment centres in the Netherlands between 2000 and 2019 were assessed. We used parametric proportional hazards models with a piecewise exponential survival function to model HCV primary infection and reinfection incidence per 1000 person-years. Findings: Of the 23 590 individuals without previous HCV infection, 1269 cases of HCV primary infection were documented (incidence 5·2 per 1000 person-years [95% CI 5·0–5·5]). The highest incidence was observed in men who have sex with men (MSM; 7·7 per 1000 person-years [7·3–8·2]) and was lower in people who inject drugs (PWID; 1·7 per 1000 person-years [0·7–4·1]) and other key populations (1·0 per 1000 person-years [0·8–1·2]). In MSM, incidence increased in 2007 to 14·3 per 1000 person-years and fluctuated between 8·7 and 13·0 per 1000 person-years from 2008 to 2015. In 2016, incidence declined to 6·1 cases per 1000 person-years and remained steady between 4·1 and 4·9 per 1000 person-years from 2017 to 2019. Of the 1866 individuals with a previous HCV infection, 274 reinfections were documented (incidence 26·9 per 1000 person-years [95% CI 23·9–30·3]). The highest incidence rate was observed in MSM (38·5 per 1000 person-years [33·9–43·7]) and was lower in PWID (10·9 per 1000 person-years [3·5–33·8]) and other key populations (8·9 per 1000 person-years [6·3–12·5]). In MSM, reinfection incidence fluctuated between 38·0 and 88·9 per 1000 person-years from 2006 to 2015, reaching 55·6 per 1000 person-years in 2015. In 2016, reinfection incidence declined to 41·4 per 1000 person-years, followed by further decreases to 24·4 per 1000 person-years in 2017 and 11·4 per 1000 person-years in 2019. Interpretation: The sharp decline in HCV incidence in MSM with HIV shortly after restrictions on DAAs were lifted suggests a treatment-as-prevention effect. HCV incidence was already low in PWID and other groups before unrestricted access. Ongoing HCV transmission is occurring in MSM, as illustrated by a declining but high rate of reinfection, stressing the need for additional preventive measures. Funding: Dutch Ministry of Health, Welfare, and Sport.",

author = "Colette Smit and Anders Boyd and Rijnders, {Bart J.A.} and {van de Laar}, {Thijs J.W.} and Leyten, {Eliane M.} and Bierman, {Wouter F.} and Kees Brinkman and Claassen, {Mark A.A.} and {den Hollander}, Jan and Anne Boerekamps and Newsum, {Astrid M.} and Janke Schinkel and Maria Prins and Arends, {Joop E.} and {Op de Coul}, {Eline L.M.} and {van der Valk}, Marc and Peter Reiss and {van der Valk}, M. and Geerlings, {S. E.} and A. Goorhuis and Hovius, {J. W.} and B. Lempkes and J. Nellen and {van der Poll}, T. and Prins, {J. M.} and {van Vugt}, M. and Wiersinga, {W. J.} and Wit, {F. W.M.N.} and {van Duinen}, M. and {van Eden}, J. and A. Hazenberg and {van Hes}, {A. M.H.} and Pijnappel, {F. J.J.} and Smalhout, {S. Y.} and Weijsenfeld, {A. M.} and S. Jurriaans and Back, {N. K.T.} and Zaaijer, {H. L.} and B. Berkhout and Cornelissen, {M. T.E.} and Schinkel, {C. J.} and Wolthers, {K. C.} and Peters, {E. J.G.} and {van Agtmael}, {M. A.} and Autar, {R. S.} and M. Bomers and Sigaloff, {K. C.E.} and M. Heitmuller and Laan, {L. M.} and Ang, {C. W.} and {van Houdt}, R. and M. Jonges and {van den Berge}, M. and A. Stegeman and S. Baas and {Hage de Looff}, L. and A. Buiting and A. Reuwer and J. Veenemans and B. Wintermans and Pronk, {M. J.H.} and Ammerlaan, {H. S.M.} and {van den Bersselaar}, {D. N.J.} and {de Munnik}, {E. S.} and B. Deiman and Jansz, {A. R.} and V. Scharnhorst and J. Tjhie and Wegdam, {M. C.A.} and {van Eeden}, A. and J. Nellen and W. Brokking and Elsenburg, {L. J.M.} and H. Nobel and {van Kasteren}, {M. E.E.} and Berrevoets, {M. A.H.} and Brouwer, {A. E.} and A. Adams and {van Erve}, R. and {de Kruijf-van de Wiel}, {B. A.F.M.} and S. Keelan-Phaf and {van de Ven}, B. and Buiting, {A. G.M.} and Murck, {J. L.} and {de Vries-Sluijs}, {T. E.M.S.} and Bax, {H. I.} and {van Gorp}, {E. C.M.} and {de Jong-Peltenburg}, {N. C.} and {de Mendon{\c c}a Melo}, M. and {van Nood}, E. and Nouwen, {J. L.} and Rijnders, {B. J.A.} and C. Rokx and Schurink, {C. A.M.} and L. Slobbe and A. Verbon and N. Bassant and {van Beek}, {J. E.A.} and M. Vriesde and {van Zonneveld}, {L. M.} and {de Groot}, J. and Boucher, {C. A.B.} and Koopmans, {M. P.G.} and {van Kampen}, {J. J.A.} and J. Branger and Douma, {R. A.} and Cents-Bosma, {A. S.} and {Duijf-van de Ven}, {C. J.H.M.} and Schippers, {E. F.} and {van Nieuwkoop}, C. and {van IJperen}, {J. M.} and J. Geilings and {van Burgel}, {N. D.} and Leyten, {E. M.S.} and {van der Hut}, G. and Gelinck, {L. B.S.} and F. Mollema and S. Davids-Veldhuis and C. Tearno and Wildenbeest, {G. S.} and E. Heikens and Groeneveld, {P. H.P.} and Bouwhuis, {J. W.} and Lammers, {A. J.J.} and S. Kraan and {van Hulzen}, {A. G.W.} and Kruiper, {M. S.M.} and {van der Bliek}, {G. L.} and Bor, {P. C.J.} and Debast, {S. B.} and Wagenvoort, {G. H.J.} and Kroon, {F. P.} and {de Boer}, {M. G.J.} and H. Jolink and Lambregts, {M. M.C.} and Roukens, {A. H.E.} and H. Scheper and W. Dorama and {van Holten}, N. and Claas, {E. C.J.} and E. Wessels and {den Hollander}, {J. G.} and Brouwer, {C. J.} and Smit, {J. V.} and D. Struik-Kalkman and {van Niekerk}, T. and {El Moussaoui}, R. and K. Pogany and O. Pontesilli and Lowe, {S. H.} and {Oude Lashof}, {A. M.L.} and D. Posthouwer and {van Wolfswinkel}, {M. E.} and Ackens, {R. P.} and K. Burgers and J. Schippers and B. Weijenberg-Maes and {van Loo}, {I. H.M.} and Havenith, {T. R.A.} and {van Vonderen}, {M. G.A.} and Kampschreur, {L. M.} and S. Faber and R. Steeman-Bouma and {Al Moujahid}, A. and Kootstra, {G. J.} and Delsing, {C. E.} and {van der Burg-van de Plas}, M. and L. Scheiberlich and W. Kortmann and {van Twillert}, G. and R. Renckens and D. Ruiter-Pronk and {van Truijen-Oud}, {F. A.} and {Cohen Stuart}, {J. W.T.} and Jansen, {E. R.} and M. Hoogewerf and W. Rozemeijer and {van der Reijden}, {W. A.} and Sinnige, {J. C.} and K. Brinkman and {van den Berk}, {G. E.L.} and Blok, {W. L.} and Lettinga, {K. D.} and {de Regt}, M. and Schouten, {W. E.M.} and Stalenhoef, {J. E.} and J. Veenstra and Vrouenraets, {S. M.E.} and H. Blaauw and Geerders, {G. F.} and Kleene, {M. J.} and M. Kok and M. Knapen and {van der Mech{\'e}}, {I. B.} and E. Mulder-Seeleman and Toonen, {A. J.M.} and S. Wijnands and E. Wttewaal and D. Kwa and {van Crevel}, R. and Dofferhoff, {A. S.M.} and {ter Hofstede}, {H. J.M.} and J. Hoogerwerf and M. Keuter and O. Richel and M. Albers and Grintjes-Huisman, {K. J.T.} and {de Haan}, M. and M. Marneef and R. Strik-Albers and J. Rahamat-Langendoen and Stelma, {F. F.} and D. Burger and Gisolf, {E. H.} and Hassing, {R. J.} and M. Claassen and {ter Beest}, G. and {van Bentum}, {P. H.M.} and N. Langebeek and R. Tiemessen and Swanink, {C. M.A.} and {van Lelyveld}, {S. F.L.} and R. Soetekouw and {van der Prijt}, {L. M.M.} and {van der Swaluw}, J. and N. Bermon and R. Jansen and Herpers, {B. L.} and D. Veenendaal and Verhagen, {D. W.M.} and Lauw, {F. N.} and {van Broekhuizen}, {M. C.} and {van Wijk}, M. and Bierman, {W. F.W.} and M. Bakker and J. Kleinnijenhuis and E. Kloeze and A. Middel and Postma, {D. F.} and Y. Stienstra and M. Wouthuyzen-Bakker and A. Boonstra and {de Groot-de Jonge}, H. and {van der Meulen}, {P. A.} and {de Weerd}, {D. A.} and Niesters, {H. G.M.} and {van Leer-Buter}, {C. C.} and M. Knoester and Hoepelman, {A. I.M.} and Arends, {J. E.} and Barth, {R. E.} and Bruns, {A. H.W.} and Ellerbroek, {P. M.} and T. Mudrikova and Oosterheert, {J. J.} and Schadd, {E. M.} and {van Welzen}, {B. J.} and K. Aarsman and {Griffioen-van Santen}, {B. M.G.} and {de Kroon}, I. and {van Berkel}, M. and {van Rooijen}, {C. S.A.M.} and R. Schuurman and F. Verduyn-Lunel and Wensing, {A. M.J.} and P. Reiss and S. Zaheri and Boyd, {A. C.} and Bezemer, {D. O.} and {van Sighem}, {A. I.} and C. Smit and M. Hillebregt and {de Jong}, A. and T. Woudstra and D. Bergsma and R. Meijering and {van de Sande}, L. and T. Rutkens and {van der Vliet}, S. and {de Groot}, L. and {van den Akker}, M. and Y. Bakker and {El Berkaoui}, A. and M. Bezemer and N. Br{\'e}tin and E. Djoechro and M. Groters and E. Kruijne and Lelivelt, {K. J.} and C. Lodewijk and E. Lucas and L. Munjishvili and F. Paling and B. Peeck and C. Ree and R. Regtop and Y. Ruijs and M. Schoorl and P. Schn{\"o}rr and A. Scheigrond and E. Tuijn and L. Veenenberg and Visser, {K. M.} and Witte, {E. C.} and {ATHENA observational cohort}",

note = "Funding Information: BJAR reports grants from MSD and Gilead, outside the submitted work and is a member of advisory boards for MSD, Gilead, Pfizer, ViiV Healthcare, Jansen-Cilag, and Abbvie. WFB reports reimbursement of costs inclusion patient in industry-sponsored RCT from GSK and non-financial support from Janssen, all outside the submitted work. KB is an advisory board member for ViiV Healthcare, Gilead, MSD, and Janssen; and reports grants form ViiV Healthcare and Gilead. JS reports grants from Gilead Sciences, outside the submitted work. MP reports grants, personal fees, speakers fees and independent scientific support to their institution from Gilead Sciences, Roche, MSD, and Abbvie, all outside the submitted work. JEA reports fees paid to their institution from Gilead, Janssen-Cilag, Abbvie, Bristol-Myers Squibb, and MSD for advisory membership, all outside the submitted work. MvdV reports grants and personal fees from Abbvie, Gilead, Johnson & Johnson, MSD, and ViiV Healthcare, all outside the submitted work. PR reports grants from Gilead, ViiV Healthcare, and Merck & Co; and honoraria and is an advisory board member for Gilead Sciences, ViiV Healthcare, Merck & Co, and Teva Pharmaceutical Industries, all outside the submitted work. All other authors report no competing interests. Publisher Copyright: {\textcopyright} 2021 Elsevier Ltd Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

month = feb,

doi = "10.1016/S2352-3018(20)30301-5",

language = "English",

volume = "8",

pages = "e96--e105",

journal = "The Lancet HIV",

issn = "2352-3018",

publisher = "Elsevier Limited",

number = "2",

}

TY - JOUR

T1 - HCV micro-elimination in individuals with HIV in the Netherlands 4 years after universal access to direct-acting antivirals

T2 - a retrospective cohort study

AU - Smit, Colette

AU - Boyd, Anders

AU - Rijnders, Bart J.A.

AU - van de Laar, Thijs J.W.

AU - Leyten, Eliane M.

AU - Bierman, Wouter F.

AU - Brinkman, Kees

AU - Claassen, Mark A.A.

AU - den Hollander, Jan

AU - Boerekamps, Anne

AU - Newsum, Astrid M.

AU - Schinkel, Janke

AU - Prins, Maria

AU - Arends, Joop E.

AU - Op de Coul, Eline L.M.

AU - van der Valk, Marc

AU - Reiss, Peter

AU - van der Valk, M.

AU - Geerlings, S. E.

AU - Goorhuis, A.

AU - Hovius, J. W.

AU - Lempkes, B.

AU - Nellen, J.

AU - van der Poll, T.

AU - Prins, J. M.

AU - van Vugt, M.

AU - Wiersinga, W. J.

AU - Wit, F. W.M.N.

AU - van Duinen, M.

AU - van Eden, J.

AU - Hazenberg, A.

AU - van Hes, A. M.H.

AU - Pijnappel, F. J.J.

AU - Smalhout, S. Y.

AU - Weijsenfeld, A. M.

AU - Jurriaans, S.

AU - Back, N. K.T.

AU - Zaaijer, H. L.

AU - Berkhout, B.

AU - Cornelissen, M. T.E.

AU - Schinkel, C. J.

AU - Wolthers, K. C.

AU - Peters, E. J.G.

AU - van Agtmael, M. A.

AU - Autar, R. S.

AU - Bomers, M.

AU - Sigaloff, K. C.E.

AU - Heitmuller, M.

AU - Laan, L. M.

AU - Ang, C. W.

AU - van Houdt, R.

AU - Jonges, M.

AU - van den Berge, M.

AU - Stegeman, A.

AU - Baas, S.

AU - Hage de Looff, L.

AU - Buiting, A.

AU - Reuwer, A.

AU - Veenemans, J.

AU - Wintermans, B.

AU - Pronk, M. J.H.

AU - Ammerlaan, H. S.M.

AU - van den Bersselaar, D. N.J.

AU - de Munnik, E. S.

AU - Deiman, B.

AU - Jansz, A. R.

AU - Scharnhorst, V.

AU - Tjhie, J.

AU - Wegdam, M. C.A.

AU - van Eeden, A.

AU - Nellen, J.

AU - Brokking, W.

AU - Elsenburg, L. J.M.

AU - Nobel, H.

AU - van Kasteren, M. E.E.

AU - Berrevoets, M. A.H.

AU - Brouwer, A. E.

AU - Adams, A.

AU - van Erve, R.

AU - de Kruijf-van de Wiel, B. A.F.M.

AU - Keelan-Phaf, S.

AU - van de Ven, B.

AU - Buiting, A. G.M.

AU - Murck, J. L.

AU - de Vries-Sluijs, T. E.M.S.

AU - Bax, H. I.

AU - van Gorp, E. C.M.

AU - de Jong-Peltenburg, N. C.

AU - de Mendonça Melo, M.

AU - van Nood, E.

AU - Nouwen, J. L.

AU - Rijnders, B. J.A.

AU - Rokx, C.

AU - Schurink, C. A.M.

AU - Slobbe, L.

AU - Verbon, A.

AU - Bassant, N.

AU - van Beek, J. E.A.

AU - Vriesde, M.

AU - van Zonneveld, L. M.

AU - de Groot, J.

AU - Boucher, C. A.B.

AU - Koopmans, M. P.G.

AU - van Kampen, J. J.A.

AU - Branger, J.

AU - Douma, R. A.

AU - Cents-Bosma, A. S.

AU - Duijf-van de Ven, C. J.H.M.

AU - Schippers, E. F.

AU - van Nieuwkoop, C.

AU - van IJperen, J. M.

AU - Geilings, J.

AU - van Burgel, N. D.

AU - Leyten, E. M.S.

AU - van der Hut, G.

AU - Gelinck, L. B.S.

AU - Mollema, F.

AU - Davids-Veldhuis, S.

AU - Tearno, C.

AU - Wildenbeest, G. S.

AU - Heikens, E.

AU - Groeneveld, P. H.P.

AU - Bouwhuis, J. W.

AU - Lammers, A. J.J.

AU - Kraan, S.

AU - van Hulzen, A. G.W.

AU - Kruiper, M. S.M.

AU - van der Bliek, G. L.

AU - Bor, P. C.J.

AU - Debast, S. B.

AU - Wagenvoort, G. H.J.

AU - Kroon, F. P.

AU - de Boer, M. G.J.

AU - Jolink, H.

AU - Lambregts, M. M.C.

AU - Roukens, A. H.E.

AU - Scheper, H.

AU - Dorama, W.

AU - van Holten, N.

AU - Claas, E. C.J.

AU - Wessels, E.

AU - den Hollander, J. G.

AU - Brouwer, C. J.

AU - Smit, J. V.

AU - Struik-Kalkman, D.

AU - van Niekerk, T.

AU - El Moussaoui, R.

AU - Pogany, K.

AU - Pontesilli, O.

AU - Lowe, S. H.

AU - Oude Lashof, A. M.L.

AU - Posthouwer, D.

AU - van Wolfswinkel, M. E.

AU - Ackens, R. P.

AU - Burgers, K.

AU - Schippers, J.

AU - Weijenberg-Maes, B.

AU - van Loo, I. H.M.

AU - Havenith, T. R.A.

AU - van Vonderen, M. G.A.

AU - Kampschreur, L. M.

AU - Faber, S.

AU - Steeman-Bouma, R.

AU - Al Moujahid, A.

AU - Kootstra, G. J.

AU - Delsing, C. E.

AU - van der Burg-van de Plas, M.

AU - Scheiberlich, L.

AU - Kortmann, W.

AU - van Twillert, G.

AU - Renckens, R.

AU - Ruiter-Pronk, D.

AU - van Truijen-Oud, F. A.

AU - Cohen Stuart, J. W.T.

AU - Jansen, E. R.

AU - Hoogewerf, M.

AU - Rozemeijer, W.

AU - van der Reijden, W. A.

AU - Sinnige, J. C.

AU - Brinkman, K.

AU - van den Berk, G. E.L.

AU - Blok, W. L.

AU - Lettinga, K. D.

AU - de Regt, M.

AU - Schouten, W. E.M.

AU - Stalenhoef, J. E.

AU - Veenstra, J.

AU - Vrouenraets, S. M.E.

AU - Blaauw, H.

AU - Geerders, G. F.

AU - Kleene, M. J.

AU - Kok, M.

AU - Knapen, M.

AU - van der Meché, I. B.

AU - Mulder-Seeleman, E.

AU - Toonen, A. J.M.

AU - Wijnands, S.

AU - Wttewaal, E.

AU - Kwa, D.

AU - van Crevel, R.

AU - Dofferhoff, A. S.M.

AU - ter Hofstede, H. J.M.

AU - Hoogerwerf, J.

AU - Keuter, M.

AU - Richel, O.

AU - Albers, M.

AU - Grintjes-Huisman, K. J.T.

AU - de Haan, M.

AU - Marneef, M.

AU - Strik-Albers, R.

AU - Rahamat-Langendoen, J.

AU - Stelma, F. F.

AU - Burger, D.

AU - Gisolf, E. H.

AU - Hassing, R. J.

AU - Claassen, M.

AU - ter Beest, G.

AU - van Bentum, P. H.M.

AU - Langebeek, N.

AU - Tiemessen, R.

AU - Swanink, C. M.A.

AU - van Lelyveld, S. F.L.

AU - Soetekouw, R.

AU - van der Prijt, L. M.M.

AU - van der Swaluw, J.

AU - Bermon, N.

AU - Jansen, R.

AU - Herpers, B. L.

AU - Veenendaal, D.

AU - Verhagen, D. W.M.

AU - Lauw, F. N.

AU - van Broekhuizen, M. C.

AU - van Wijk, M.

AU - Bierman, W. F.W.

AU - Bakker, M.

AU - Kleinnijenhuis, J.

AU - Kloeze, E.

AU - Middel, A.

AU - Postma, D. F.

AU - Stienstra, Y.

AU - Wouthuyzen-Bakker, M.

AU - Boonstra, A.

AU - de Groot-de Jonge, H.

AU - van der Meulen, P. A.

AU - de Weerd, D. A.

AU - Niesters, H. G.M.

AU - van Leer-Buter, C. C.

AU - Knoester, M.

AU - Hoepelman, A. I.M.

AU - Arends, J. E.

AU - Barth, R. E.

AU - Bruns, A. H.W.

AU - Ellerbroek, P. M.

AU - Mudrikova, T.

AU - Oosterheert, J. J.

AU - Schadd, E. M.

AU - van Welzen, B. J.

AU - Aarsman, K.

AU - Griffioen-van Santen, B. M.G.

AU - de Kroon, I.

AU - van Berkel, M.

AU - van Rooijen, C. S.A.M.

AU - Schuurman, R.

AU - Verduyn-Lunel, F.

AU - Wensing, A. M.J.

AU - Reiss, P.

AU - Zaheri, S.

AU - Boyd, A. C.

AU - Bezemer, D. O.

AU - van Sighem, A. I.

AU - Smit, C.

AU - Hillebregt, M.

AU - de Jong, A.

AU - Woudstra, T.

AU - Bergsma, D.

AU - Meijering, R.

AU - van de Sande, L.

AU - Rutkens, T.

AU - van der Vliet, S.

AU - de Groot, L.

AU - van den Akker, M.

AU - Bakker, Y.

AU - El Berkaoui, A.

AU - Bezemer, M.

AU - Brétin, N.

AU - Djoechro, E.

AU - Groters, M.

AU - Kruijne, E.

AU - Lelivelt, K. J.

AU - Lodewijk, C.

AU - Lucas, E.

AU - Munjishvili, L.

AU - Paling, F.

AU - Peeck, B.

AU - Ree, C.

AU - Regtop, R.

AU - Ruijs, Y.

AU - Schoorl, M.

AU - Schnörr, P.

AU - Scheigrond, A.

AU - Tuijn, E.

AU - Veenenberg, L.

AU - Visser, K. M.

AU - Witte, E. C.

AU - ATHENA observational cohort

N1 - Funding Information: BJAR reports grants from MSD and Gilead, outside the submitted work and is a member of advisory boards for MSD, Gilead, Pfizer, ViiV Healthcare, Jansen-Cilag, and Abbvie. WFB reports reimbursement of costs inclusion patient in industry-sponsored RCT from GSK and non-financial support from Janssen, all outside the submitted work. KB is an advisory board member for ViiV Healthcare, Gilead, MSD, and Janssen; and reports grants form ViiV Healthcare and Gilead. JS reports grants from Gilead Sciences, outside the submitted work. MP reports grants, personal fees, speakers fees and independent scientific support to their institution from Gilead Sciences, Roche, MSD, and Abbvie, all outside the submitted work. JEA reports fees paid to their institution from Gilead, Janssen-Cilag, Abbvie, Bristol-Myers Squibb, and MSD for advisory membership, all outside the submitted work. MvdV reports grants and personal fees from Abbvie, Gilead, Johnson & Johnson, MSD, and ViiV Healthcare, all outside the submitted work. PR reports grants from Gilead, ViiV Healthcare, and Merck & Co; and honoraria and is an advisory board member for Gilead Sciences, ViiV Healthcare, Merck & Co, and Teva Pharmaceutical Industries, all outside the submitted work. All other authors report no competing interests. Publisher Copyright: © 2021 Elsevier Ltd Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/2

Y1 - 2021/2

N2 - Background: In the Netherlands, access to direct-acting antivirals (DAAs) against hepatitis C virus (HCV) has been unrestricted for chronic infection since 2015. We evaluated whether the nationwide incidence of HCV infections in individuals with HIV has changed since 2015. Methods: In this retrospective cohort study, data from the ATHENA cohort of people with HIV aged 18 years or older attending any of the 24 HIV treatment centres in the Netherlands between 2000 and 2019 were assessed. We used parametric proportional hazards models with a piecewise exponential survival function to model HCV primary infection and reinfection incidence per 1000 person-years. Findings: Of the 23 590 individuals without previous HCV infection, 1269 cases of HCV primary infection were documented (incidence 5·2 per 1000 person-years [95% CI 5·0–5·5]). The highest incidence was observed in men who have sex with men (MSM; 7·7 per 1000 person-years [7·3–8·2]) and was lower in people who inject drugs (PWID; 1·7 per 1000 person-years [0·7–4·1]) and other key populations (1·0 per 1000 person-years [0·8–1·2]). In MSM, incidence increased in 2007 to 14·3 per 1000 person-years and fluctuated between 8·7 and 13·0 per 1000 person-years from 2008 to 2015. In 2016, incidence declined to 6·1 cases per 1000 person-years and remained steady between 4·1 and 4·9 per 1000 person-years from 2017 to 2019. Of the 1866 individuals with a previous HCV infection, 274 reinfections were documented (incidence 26·9 per 1000 person-years [95% CI 23·9–30·3]). The highest incidence rate was observed in MSM (38·5 per 1000 person-years [33·9–43·7]) and was lower in PWID (10·9 per 1000 person-years [3·5–33·8]) and other key populations (8·9 per 1000 person-years [6·3–12·5]). In MSM, reinfection incidence fluctuated between 38·0 and 88·9 per 1000 person-years from 2006 to 2015, reaching 55·6 per 1000 person-years in 2015. In 2016, reinfection incidence declined to 41·4 per 1000 person-years, followed by further decreases to 24·4 per 1000 person-years in 2017 and 11·4 per 1000 person-years in 2019. Interpretation: The sharp decline in HCV incidence in MSM with HIV shortly after restrictions on DAAs were lifted suggests a treatment-as-prevention effect. HCV incidence was already low in PWID and other groups before unrestricted access. Ongoing HCV transmission is occurring in MSM, as illustrated by a declining but high rate of reinfection, stressing the need for additional preventive measures. Funding: Dutch Ministry of Health, Welfare, and Sport.

AB - Background: In the Netherlands, access to direct-acting antivirals (DAAs) against hepatitis C virus (HCV) has been unrestricted for chronic infection since 2015. We evaluated whether the nationwide incidence of HCV infections in individuals with HIV has changed since 2015. Methods: In this retrospective cohort study, data from the ATHENA cohort of people with HIV aged 18 years or older attending any of the 24 HIV treatment centres in the Netherlands between 2000 and 2019 were assessed. We used parametric proportional hazards models with a piecewise exponential survival function to model HCV primary infection and reinfection incidence per 1000 person-years. Findings: Of the 23 590 individuals without previous HCV infection, 1269 cases of HCV primary infection were documented (incidence 5·2 per 1000 person-years [95% CI 5·0–5·5]). The highest incidence was observed in men who have sex with men (MSM; 7·7 per 1000 person-years [7·3–8·2]) and was lower in people who inject drugs (PWID; 1·7 per 1000 person-years [0·7–4·1]) and other key populations (1·0 per 1000 person-years [0·8–1·2]). In MSM, incidence increased in 2007 to 14·3 per 1000 person-years and fluctuated between 8·7 and 13·0 per 1000 person-years from 2008 to 2015. In 2016, incidence declined to 6·1 cases per 1000 person-years and remained steady between 4·1 and 4·9 per 1000 person-years from 2017 to 2019. Of the 1866 individuals with a previous HCV infection, 274 reinfections were documented (incidence 26·9 per 1000 person-years [95% CI 23·9–30·3]). The highest incidence rate was observed in MSM (38·5 per 1000 person-years [33·9–43·7]) and was lower in PWID (10·9 per 1000 person-years [3·5–33·8]) and other key populations (8·9 per 1000 person-years [6·3–12·5]). In MSM, reinfection incidence fluctuated between 38·0 and 88·9 per 1000 person-years from 2006 to 2015, reaching 55·6 per 1000 person-years in 2015. In 2016, reinfection incidence declined to 41·4 per 1000 person-years, followed by further decreases to 24·4 per 1000 person-years in 2017 and 11·4 per 1000 person-years in 2019. Interpretation: The sharp decline in HCV incidence in MSM with HIV shortly after restrictions on DAAs were lifted suggests a treatment-as-prevention effect. HCV incidence was already low in PWID and other groups before unrestricted access. Ongoing HCV transmission is occurring in MSM, as illustrated by a declining but high rate of reinfection, stressing the need for additional preventive measures. Funding: Dutch Ministry of Health, Welfare, and Sport.

UR - http://www.scopus.com/inward/record.url?scp=85099055446&partnerID=8YFLogxK

U2 - 10.1016/S2352-3018(20)30301-5

DO - 10.1016/S2352-3018(20)30301-5

M3 - Article

AN - SCOPUS:85099055446

VL - 8

SP - e96-e105

JO - The Lancet HIV

JF - The Lancet HIV

SN - 2352-3018

IS - 2

ER -

HCV micro-elimination in individuals with HIV in the Netherlands 4 years after universal access to direct-acting antivirals: a retrospective cohort study

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