Can Australia reach the World Health Organization Hepatitis C elimination goal by 2025 among HIV-positive gay and bisexual men?

Boettiger, David C; Salazar Vizcaya, Luisa Paola; Dore, Gregory J; Gray, Richard T; Law, Matthew G; Callander, Denton; Lea, Toby; Rauch, Andri; Matthews, Gail V (2020). Can Australia reach the World Health Organization Hepatitis C elimination goal by 2025 among HIV-positive gay and bisexual men? Clinical infectious diseases, 70(1), pp. 106-113. Oxford University Press 10.1093/cid/ciz164

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BACKGROUND

HIV-positive gay and bisexual men (GBM) in Australia are well engaged in clinical care. We hypothesized that the World Health Organization's hepatitis C virus (HCV) elimination target of an 80% reduction in incidence by 2030 may be reachable ahead of time in this population.

METHODS

We predicted the effect of treatment and behavioral changes on HCV incidence among HIV-positive GBM up to 2025 using a HCV transmission model parameterized with Australian data. We assessed the impact of changes in behavior that may facilitate HCV transmission in the context of different rates of direct-acting antiviral (DAA) use.

RESULTS

HCV incidence in our model increased from 0.7 per 100 person years in 2000 to 2.5 per 100 person years in 2016, and had the same trajectory as previously reported clinical data. If the proportion of eligible (HCV RNA positive) patients using DAAs stays at 65%/year between 2016-2025, with high-risk sexual behavior and injecting drug use remaining at current levels, HCV incidence would drop to 0.4 per 100 person years (85% decline from 2016). In the same treatment scenario but with substantial increases in risk behavior, HCV incidence would drop to 0.6 per 100 person years (76% decline from 2016). If the proportion of eligible patients using DAAs dropped from 65%/year in 2016 to 20%/year in 2025 and risk behavior did not change, HCV incidence would drop to 0.7 per 100 person years (70% reduction from 2016).

CONCLUSIONS

Reaching the World Health Organization HCV elimination target by 2025 among HIV-positive GBM in Australia is achievable.

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