New Data Raise a Tantalizing Question: Can We Eradicate HIV/HCV Coinfection?

The landscape of hepatitis C (HCV) coinfection in people with HIV has shifted considerably over the past two decades, particularly with respect to cure rates and acquisition factors. Recently published research out of Spain encapsulates just how much has changed—while data on cirrhosis and reinfection remind us that the need remains strong for HCV testing and post-cure follow-up.

Highlighted Study Population and Methods

Investigators analyzed nine cross-sectional surveys conducted over 21 years in Spain.

Anti-HCV antibody prevalence and active HCV infection (defined as positive HCV-RNA PCR) were assessed. Results were stratified by HIV transmission category and eras before and after direct-acting HCV antivirals (DAAs) became widely available in Spain in 2015.

The study population was people with HIV in Spain, monitored from approximately 40 treatment centers between 2002 and 2023. Annual reference population varied by study but ranged between 31,800 and 47,006 individuals. Of note, the demographics of HIV acquisition changed during the study period: People who injected drugs accounted for 55% of new HIV diagnoses in 2002, but decreased to 21% in 2023, while men who have sex with men (MSM) rose from 17% of transmissions to 46%.

Key Findings

HCV seroprevalence decreased from 60.8% (2002) to 27.4% (2023).
Active HCV infection decreased from 46.3% (2002) to 0.9% (2023)—and 0% among heterosexuals—while remaining <1% since 2021.
Treatment uptake dramatically improved over the study period: from 23% (2002) to 99% (2023, all-oral DAAs era).
In the DAA era (2015–2023), active HCV declined by 100% in heterosexuals, 94% in people who inject drugs, and 71% in MSM.
Cirrhosis in active HCV cases peaked at 23.1% (2015) before dropping to 0% (2021).
That said, among those who achieved sustained virological response (SVR) in 2023, 20% had cirrhosis.

Read an expert analysis from Benjamin Young, M.D., Ph.D. here.

Source: TheBodyPro