1. Modeling HIV-HCV coinfection epidemiology in the direct-acting antiviral era: the road to elimination.
- Author
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Virlogeux, Victor, Zoulim, Fabien, Pugliese, Pascal, Poizot-Martin, Isabelle, Valantin, Marc-Antoine, Cuzin, Lise, Reynes, Jacques, Billaud, Eric, Huleux, Thomas, Bani-Sadr, Firouze, Rey, David, Frésard, Anne, Jacomet, Christine, Duvivier, Claudine, Cheret, Antoine, Hustache-Mathieu, Laurent, Hoen, Bruno, Cabié, André, Cotte, Laurent, and Dat’AIDS Study Group
- Subjects
HIV infections ,HEPATITIS C virus ,MIXED infections ,EPIDEMIOLOGY ,ANTIVIRAL agents - Abstract
Background: HCV treatment uptake has drastically increased in HIV-HCV coinfected patients in France since direct-acting antiviral (DAA) treatment approval, resulting in HCV cure in 63% of all HIV-HCV patients by the end of 2015. We investigated the impact of scaling-up DAA on HCV prevalence in the whole HIV population and in various risk groups over the next 10 years in France using a transmission dynamic compartmental model.Methods: The model was based on epidemiological data from the French Dat'AIDS cohort. Eight risk groups were considered, including high-risk (HR) and low-risk (LR) men who have sex with men (MSM) and male/female heterosexuals, intra-venous drug users, or patients from other risk groups. The model was calibrated on prevalence and incidence data observed in the cohort between 2012 and 2015.Results: On January 1, 2016, 156,811 patients were registered as infected with HIV in France (24,900 undiagnosed patients) of whom 7938 (5.1%) had detectable HCV-RNA (722 undiagnosed patients). Assuming a treatment coverage (TC) rate of 30%/year (i.e., the observed rate in 2015), model projections showed that HCV prevalence among HIV patients is expected to drop to 0.81% in 2026. Sub-analyses showed a similar decrease of HIV-HCV prevalence in most risk groups, including LR MSM. Due to higher infection and reinfection rates, predicted prevalence in HR MSM remained stable from 6.96% in 2016 to 6.34% in 2026. Increasing annual TC rate in HR MSM to 50/70% would decrease HCV prevalence in this group to 2.35/1.25% in 2026. With a 30% TC rate, undiagnosed patients would account for 34% of HCV infections in 2026.Conclusions: Our model suggests that DAA could nearly eliminate coinfection in France within 10 years for most risk groups, including LR MSM. Elimination in HR MSM will require increased TC. [ABSTRACT FROM AUTHOR]- Published
- 2017
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