New hepatitis C infections among HIV-positive gay men drop by half after direct-acting antiviral roll-out in Netherlands
A little more than a year after the Netherlands
instituted a policy allowing unrestricted access to direct-acting antivirals
for the treatment of hepatitis C, researchers have already seen a dramatic
decline in acute HCV infections among one at-risk population, HIV-positive men
who have sex with men.
These findings were reported Thursday at the
Conference on Retroviruses and Opportunistic Infections (CROI 2017) in Seattle,
in a session that also included presentations on rising incidence of HCV infection
among HIV-positive gay men in San Diego and predictions about eradication of
HIV/HCV co-infection in France.
Starting in the early 2000s researchers began to
report outbreaks of acute hepatitis C in European cities. Although sexual
transmission of HCV is rare overall, it occurs more often among HIV-positive
men who have sex with men (MSM).
The advent of direct-acting antivirals (DAAs) used in
interferon-free regimens has made hepatitis C treatment faster, easier and much
more effective, with cure rates exceeding 90%. Promptly treating everyone
infected with HCV, especially those in high-risk groups such as sexually active
gay men and people who continue to inject drugs, could cut transmission – a
concept known as 'treatment as prevention'. But in many countries access to
DAAs has been limited due to their high cost, including restrictions around
liver disease severity and abstinence from drugs or alcohol.