Ongoing Transmission of HCV Infection in Community Recruited People Who Inject Drugs in Athens, Greece (2018-2020)

Author: Sotirios Roussos George Kalamitsis Theodoros Angelopoulos Savvas Chaikalis Dimitrios Paraskevis Georgios Papatheodoridis Angelos Hatzakis Vana Sypsa

Theme: Epidemiology & Public Health Research Year: 2022

An outbreak of HIV infection occurred among People Who Inject Drugs (PWID) in Athens,
Greece, in 2011 and high levels of HCV transmission were documented. We aim to assess HCV
transmission in 2018-2020 in a sample of community-recruited PWID.
ARISTOTLE HCV-HIV was a “seek-test-treat” program implemented in two rounds (April 2018-
February 2019, N=1365; August 2019-February 2020, N=578, discontinued due to the COVID19 pandemic). PWID were recruited using Respondent-Driven Sampling and could participate
in both rounds. Participation included interviewing, HCV/HIV testing and counseling. We
assessed anti-HCV prevalence at first participation among “new injectors” (≤2 years injecting
drug use) as a crude proxy for incidence. We also estimated HCV incidence from 55 initially
seronegative PWID who participated in both rounds. The seroconversion time was estimated
using the midpoint between negative and positive test dates.
In total, 1,630 PWID were recruited. Participants had a mean (SD) age of 39.2 (8.3) years;
83.6% were male, 26.7% homeless, 75.0% current PWID (injection in the past 30 days), 77.0%
not linked to opioid substitution treatment, 7.7% “new” injectors. Anti-HCV prevalence was
39.2% (95% Confidence Interval [95% CI]: 30.6, 48.3) among “new” injectors. HCV incidence
was 13.8 cases/100 person-years (95% CI: 7.2, 26.5).
In a sample of high-risk PWID (current injectors, not linked to opioid substitution treatment)
in 2018-2020, 4 out of 10 became HCV infected within the first 2 years of injecting drugs. This
is slightly lower as compared to a previous estimate for 2012-2013 (49.9% (95% CI:45.0%,
54.7%). However, this proxy measure and the estimated incidence rate highlight high levels
of HCV transmission in this population and failure to meet the HCV elimination target for
reduction in incidence.
A Disclosure of Interest Statement:
The ARISTOTLE HCV-HIV program was funded by Gilead Sciences. Additional support: AbbVie,
MSD, and Hellenic Scientific Society for the Study of AIDS STDs and Emerging Diseases.
GK has received a grant by Gilead Sciences.
DP has received grants by Gilead, GSK, Janssen, and MSD.
GP has served as a lecturer/advisor of AbbVie, Amgen, Dicerna, Gilead Sciences,
GlaxoSmithKline, Janssen, Ipsen, Merck Sharp & Dohme, Novartis, Roche, Spring-Bank, and
research support from AbbVie, and Gilead Sciences.
AH has participated in advisory boards for Gilead, AbbVie, BMS and received unrestricted
grants: from AbbVie, BMS, Gilead, MSD, Novartis. He is Co-Chair of Hepatitis B & C Public
Policy Association funded by AbbVie, Gilead, and MSD.
VS has received a grant by Gilead Sciences and AbbVie for the submitted work. She has served
as a lecturer for Gilead, AbbVie, and Janssen.
SR, TA, and SC have no conflict of interest to declare.

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