Theme: Clinical Research Year: 2024
Background: A nationwide HCV elimination campaign was initiatied in Iceland in 2016 to reduce the incidence of the disease in accordance with the goals of the World Health Organization. During 2000-2015 interferon-based therapies were used, followed by direct acting antiviral agents (DAA) in 2016-2020. The study objective was to investigate the epidemiology of HIV/HCV co-infections in Iceland and to examine the cascade of care for active HCV infections during this period.
Methods: A nationwide analysis of all medical records from all HIV infected individuals was conducted. Those who at some timepoint during 2000-2020 had a positive antibody against HCV were included. Medical records were reviewed along with laboratory results, antiviral treatment and outcomes. The data was analysed by treatmen era (interferon-era, 2000-2015 and DAA era, 2016-2000).
Results: The total number of persons co-infected with HIV/HCV in the years 2000-2020 was 78. Of those, 61 had documented HCV viremia (HCV RNA-positive) during the study period. In the year 2000 only 5 individuals were co-infected with HIV and HCV, with subsequent steady increase and reaching a peak in 2016, with 44 co-infected individuals. At the end of 2020 only 6 HIV infected individuals still had an active HCV infection. Analysis of the treatment cascade for 2000-2020 yielded 84 diagnosed active HCV infections among HIV-infected individuals, 81 treatment initiations and 66 cures. During the interferon-era 2000-2015, 13/29 (45%) were cured but during the DAA era 2016-2020 53/60 (88%, p<0.001) were cured.
Conclusion: Prior to a nationwide elimination campaign the number of HIV/HCV co-infections were steadily rising but have subsequently been reduced by >80%, largely as a result of treatment with DAAs. These successes need to be maintained by continued prevention, early diagnoses and continued access to DAA treatment.
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