Waging a concerted effort to conduct repeated widespread testing and treatment of hepatitis C virus (HCV) among men who have sex with men (MSM) living with HIV appears to be an effective means of preventing sexual transmission of HCV in this population.
Numerous studies have indicated that, at least in Western nations, there is a rising epidemic of sexually transmitted HCV among HIV-positive MSM. HIV-negative MSM are also at risk, although apparently to a lesser extent.
Findings from the Swiss HCVree Trial, which tested the feasibility of an effort to eliminate HCV transmission among HIV-positive MSM participants in the Swiss HIV Cohort Study, were presented at the 2018 Conference on Retroviruses and Opportunistic Infections (CROI) in Boston.
During phase A of the Swiss HCVree Trial, which ran from October 2015 through May 2016, the investigators tested 3,722 (87 percent) out of 4,257 active participants in the Swiss HIV Cohort Study. A total of 177 (4.8 percent) had hep C, 31 (18 percent) of whom had contracted that virus recently.
During phase B, which ran from June 2016 through February 2017, the investigators provided hep C treatment with Zepatier (grazoprevir/elbasvir) to all those with hep C who had genotype 1 or 4 of that virus. Those with genotypes 2 or 3 or who were not otherwise eligible for phase B were referred out for treatment with a standard hep C regimen. A total of 122 (70 percent) of the 177 people identified as having hep C received Zepatier treatment; 99 percent of them achieved a sustained virologic response 12 weeks after completing therapy (SVR12, considered a cure). An additional 39 people (22 percent) received treatment outside the study; all were cured.
Phase B also included a behavioral intervention program for MSM who reported condomless intercourse; the program was intended to reduce the risk of sexual transmission of HCV.
During the final phase C, which ran from March through November 2017, the investigators retested for HCV among 3,723 members of the cohort. Twenty-eight people (0.8 percent) had the virus, 16 (0.43 percent) of whom were recently infected and 12 of whom were individuals who were identified as having hep C during phase B and who had not received treatment for the virus.
Out of those 28 people, 22 (76 percent) started hep C treatment before the end of phase C.
During the entire study period, the investigators identified 206 cases of hep C, 183 (89 percent) of which were treated.
Of the 68 men who were eligible for the behavioral intervention program, 51 (75 percent) agreed to participate and 46 (68 percent) completed the program.
All told, the study started treatment in 89 percent of those with hep C, an effort that lowered the diagnosis rate by 50 percent during the study period.
To read the conference abstract, click here.