Establishing a framework towards monitoring HCV microelimination among men who have sex with men living with HIV in Germany: A modeling analysis

• Published in: PloS one 2022-05, Vol.17 (5), p.e0267853-e0267853
• Main Authors: Marquez, Lara K, Ingiliz, Patrick, Boesecke, Christoph, Krznaric, Ivanka, Schewe, Knud, Lutz, Thomas, Mauss, Stefan, Christensen, Stefan, Rockstroh, Jürgen K, Jain, Sonia, He, Feng, Wertheim, Joel O, Martin, Natasha K
• Format: Article
• Language: English
• Subjects: Antiviral agents; Antiviral Agents - therapeutic use; Approximation; Biology and life sciences; Coronaviruses; COVID-19; COVID-19 - epidemiology; Disease transmission; Drug therapy; Gays & lesbians; Germany - epidemiology; Health aspects; Health risks; Hepacivirus; Hepatitis C; Hepatitis C - drug therapy; Hepatitis C - epidemiology; Hepatitis C virus; Hepatitis C, Chronic - drug therapy; HIV; HIV infection; HIV Infections - drug therapy; HIV Infections - epidemiology; Homosexuality, Male; Human immunodeficiency virus; Humans; Incidence; Infections; Male; Medical diagnosis; Medicine and health sciences; Mens health; Modelling; Monitoring; Mortality; MSM (Men who have sex with men); Pandemics; People and Places; Prevention; Prospective Studies; Public health; Regulatory approval; Risk management; Risk reduction; Risk taking; Serology; Sexual and Gender Minorities; Sexually transmitted diseases; STD; Viral diseases; Viruses
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0267853

Prior to direct-acting antivirals (DAAs), HCV incidence rose among men who have sex with men (MSM) living with HIV infection in Germany despite high hepatitis C virus (HCV) treatment rates. We establish a HCV elimination modeling framework to evaluate whether existing treatment rates can achieve the World Health Organization (WHO) incidence target among MSM living with HIV in Germany. To evaluate progress towards HCV elimination in Germany, we adapted a previously published HCV transmission model among MSM living with diagnosed HIV. We modelled HCV incidence and prevalence until 2030 (relative to 2015) under existing treatment and DAA scale-up and explored potential impacts of disruptions in treatment and behavioral risk reduction due to the COVID-19 pandemic. Continuing current treatment rates will result in stable HCV incidence among MSM living with HIV in Germany between 2015-2030. The WHO HCV incidence target is achievable under DAA scale-up to 100% treatment combined with treatment of those previously diagnosed and untreated (at a rate of 15%/year) and would result in greater reductions with early treatment (3 vs 6 months) reducing incidence from 4.0/100person-years to 0.8/100person-years by 2030. A 12-month disruption to HCV treatment (20% reduction) and risk behaviors (25%,50%,75% reduction) during the COVID-19 pandemic would result in a 15% relative increase in total HCV incidence in 2030 compared to that expected under the status quo. HCV elimination among MSM living with HIV in Germany requires further DAA scale-up among those newly diagnosed combined with efforts to treat those previously diagnosed but untreated. Prospective monitoring will establish whether Germany is on track for HCV microelimination.