Cohort Profile: International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC)

Résumé fourni par la source

The International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC) is a multinational consortium of longitudinal cohorts of people with HIV who are at risk of hepatitis C virus (HCV) infection or infected with HCV. InCHEHC has been specifically designed to assess progress towards HCV elimination as a public health threat among people with HIV. The first data merge includes 104 740 participants from 11 cohorts in Australia (n = 22 033), Canada (n = 2070), France (n = 18 387), The Netherlands (n = 24 785), Spain (n = 16 725) and Switzerland (n = 20 740), with data collected between 1987 and 2021. Participants include 86 132 males (81.4%), 19 514 females (18.4%) and 191 with unknown sex at birth (0.2%); 725 (1.0%) were known to be transgender across eight cohorts collecting data on this variable. At enrolment, the median age was 38 years (interquartile range: 30–46). Of the total 104 740 participants, 12 784 (12%) had an HCV antibody or RNA positive test at or up to 1 year prior to individual cohort enrolment; 32 360 (31%) did not have an HCV RNA or antibody test recorded at that time. Clinical data are collected on all participants and behavioural and mortality data on a subset of them. Clinical data include HIV-related markers, HCV testing and treatment, liver health-related markers and sexually transmitted and blood-borne virus co-infections. Behavioural data include sexual and injecting risk behaviours and alcohol and drug use. Mortality data are collected using the International Classification of Diseases 9th or 10th revision (ICD-9/10) or Coding Causes of Death in HIV (CoDE) classification. Data are available by request from the InCHEHC steering committee. Initial requests should be directed to Rachel Sacks-Davis (rachel.sacks-davis@burnet.edu.au). Throughout the past decade, HCV treatment has been transformed by all-oral direct-acting antiviral (DAA) therapies. Whereas cure rates using previous 24–48-week treatment regimens including interferon were typically <50%, particularly for people with HIV (PHIV),1 modern treatment with DAAs cures >95% of HCV infections in 8–12 weeks.2 Prompted by the introduction of DAA therapies for HCV, in 2016 the World Health Organization (WHO) set ambitious targets to eliminate HCV as a public health threat which included reducing HCV incidence by 80% and HCV-related mortality by 65% by 20303: a major undertaking, given the estimated 59 million people infected in 2020.4 New targets to guide validating HCV elimination were added in 2021, specifying that countries should aim for an annual HCV incidence of ≤5 per 100 000 persons in the general population and ≤2 per 100 people who inject drugs.3 The absolute HCV-related annual mortality rate target is ≤2 per 100 000 persons.3 PHIV are a key population for HCV elimination, as HCV infection is more common among PHIV and also liver disease progresses more rapidly than in individuals without HIV.5–7 HIV/HCV co-infection results in higher rates of HCV-related mortality relative to those with HCV alone.8–10 Moreover, regular clinic visits for HIV care provide opportunities for (early) HCV diagnosis and treatment in this group. Modelling suggests that if HCV treatment is scaled up, the resulting decline in HCV prevalence could drive a substantial decrease in HCV incidence.11–13 In many high-income countries, DAA treatment uptake increased shortly after its introduction,14–19 and some studies have demonstrated declines in primary HCV infection incidence rates20–25 and mortality rates when DAAs became accessible.26 However, potentially high rates of post-treatment HCV reinfection are of concern.11,27 Driven by ongoing HCV-related risk behaviour (e.g. sharing of needles, syringes and other injecting equipment and condomless anal intercourse), reinfection rates among PHIV have been estimated at 3–15 per 100 person-years (PY) for an individual’s first reinfection, and up to 23 per 100 PY for subsequent reinfections prior to the availability of DAA therapies.28–30 Reinfection rates reported by single-country studies after DAA introduction vary, depending on the populations engaged in certain behaviours associated with HCV and potentially on the methodology used.27,28,31,32 For example, among people who inject drugs, a stable reinfection incidence was observed in Canada but increases were observed in Scotland.28,32 Whereas individual cohorts can assess progress toward HCV elimination targets set by the WHO, a large multinational consortium allows for cross-country comparisons using the same methodological approaches and can provide insight into the impact of policy differences. In addition, a large multinational collaboration is required to study uncommon events within individual cohorts, for example failure to reach HCV cure and behavioural drivers of HCV reinfection following successful treatment. The International Collaboration of Hepatitis C Elimination in HIV Cohorts (InCHEHC) was established in 2017 to track progress and guide policy on elimination of HCV in PHIV. InCHEHC’s first project examined the HCV care cascade among people living with HIV in five countries (Australia, Canada, France, The Netherlands and Switzerland). Since then, a cohort from Spain has joined the collaboration. The first data merge of individual-level data was conducted in 2020–21 and a new data merge is expected in 2023. Cohorts included in InCHEHC were chosen for the availability of broad access to DAA therapies in their respective country or jurisdiction while still having differences in HCV health care-related policies (e.g. HCV RNA testing), a large coverage of PHIV or a representative sample of PHIV in their setting (Table 1), longstanding cohort data among PHIV including HCV-related clinical data collection and/or detailed HCV-related behavioural data. Data from the first data merge are described in detail below. International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC): participating cohort characteristics and data availability from the first merge, data submission 2020–21 ART, antiretroviral therapy; cART, combination ART; COREVIH, Committee to coordinate the fight against sexually transmitted infections and HIV (the COREVIHs are governmental regional centres where PHIV are seen); DAA, direct-acting antivirals; ESLD, end-stage liver disease; HAART, highly-active antiretroviral therapy; HCV, hepatitis C virus; ICD-10, International Classification of Diseases 10th Revision; MSM, men who have sex with men; NA, not applicable; PHIV, people living with HIV; PWID, people who inject drugs; STI, sexually transmitted infection. Kowalska JD et al. The Coding causes Of Death in HIV (CoDe) Project. Epidemiology 2011; 22:516–23. 66% of PHIV in care in the Australian State of Victoria in the ACCESS study who were diagnosed with HCV, and HCV RNA-positive at test in when DAA therapies became to be of PHIV living with HCV in Victoria given ACCESS of PHIV in of PHIV in care in the from 18 of 23 of the 2021. on of on 2017 governmental for the governmental regional centres where PHIV are and from on HIV. In to MSM, was included in the participants from are within the participants were included in and participants from and participants from are within the ACCESS is the was and/or recorded in a for the coverage of PHIV in care in International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC): participating cohort characteristics and data availability from the first merge, data submission 2020–21 ART, antiretroviral therapy; cART, combination ART; COREVIH, Committee to coordinate the fight against sexually transmitted infections and HIV (the COREVIHs are governmental regional centres where PHIV are seen); DAA, direct-acting antivirals; ESLD, end-stage liver disease; HAART, highly-active antiretroviral therapy; HCV, hepatitis C virus; ICD-10, International Classification of Diseases 10th Revision; MSM, men who have sex with men; NA, not applicable; PHIV, people

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