Exploring the Road to HIV-HCV Eradication in the DAA Era

Coinfection with HIV and hepatitis C virus (HCV) is a common occurrence, with approximately 25% of HIV-infected patients in the United States being HCV-positive as well. According to the Centers for Disease Control and Prevention (CDC), HIV-HCV coinfection significantly increases patient risk for developing liver disease, often leading to liver-related death in coinfected individuals. A group based in France recently presented research they hope can lead to the eradication of HIV-HCV coinfection, potentially paving the way to rid the world of HCV in HIV-positive patients.

At the 2017 Conference on Retroviruses and Opportunistic infections (CROI), lead investigator, Victor Virlogeux, MD, from the Institut national de la santé et de la recherche médicale (INSERM), presented his group’s research on the eradication of HIV-HCV coinfection within the next decade. Dr. Virlogeux’s group utilized mathematical modeling to make projections on the impact direct-acting antiviral drugs (DAAs) will have on HIV-HCV infections over the next 10 years.

The study utilized data, including incidence of infection and treatment information, from the DatAIDS cohort, a collaborative effort between 15 HIV treatment centers in France. The authors examined multiple risk groups including: high-risk men who have sex with men (MSM), low-risk MSM, female and male heterosexuals, intravenous drug users (IVDU), as well as patients in additional risk categories. The researchers also examined the undiagnosed HIV-HCV coinfected population by utilizing a previously published model. Using this information, the authors examined the effect of increasing DAA coverage on HCV incidence and prevalence in the different risk groups.

Currently, among the HIV-infected population in France, approximately 5% are concurrently infected with HCV. According to the model developed by Dr. Virlogeux’s group, if DAA treatment coverage reaches 30% per year, the prevalence of HCV in most of the risk groups examined will drop to 1.31% in the year 2021 and 0.55% in 2026. However, in the high-risk MSM group, which has higher rates of acute infection as well as reinfection, DAA coverage rate of 30% is not adequate to see the same drop in HCV prevalence. The researchers predict that DAA coverage rate should increase to at least 50% to lower HCV prevalence in this high-risk group to 0.86-0.19% in 2026. The patients in the undiagnosed patient cohort will constitute the majority of HIV-HCV infected patients, accounting for 43.3% of infection in the year 2026.

The researchers conclude that their model shows that DAAs have the potential to eradicate HCV in HIV-coinfected patients in France in the next decade in the majority of the risk groups examined. However, for the high-risk MSM and undiagnosed HIV-infected patients, increased DAA coverage as well as more robust care-engagement efforts are needed to reach near-eradication.

The strengths of the study include the use of a large cohort consisting of multiple risk groups, including undiagnosed patients, as well as the fact that this is the first modeling study that looked at HIV-HCV coinfection on a country-wide scale. On the other hand, some limitations of the model utilized include failure to account for mixing between the various risk groups examined as well as not accounting for transmission of HCV from HIV-negative and HIV-positive patients.

Samar Mahmoud graduated from Drew University in 2011 with a BA in biochemistry and molecular biology. After two years of working in industry as a quality control technician for a blood bank, she went back to school and graduated from Montclair State University in 2016 with a MS in pharmaceutical biochemistry. She is currently pursuing her PhD in molecular and cellular biology at the University of Massachusetts at Amherst.