Broader Direct-Acting Antiviral Access Leads to Better Prevention of HCV

The average hepatitis C virus incidence was 52% lower during the broad-DAA access period.

Better access to direct-acting antivirals, the best treatment option for patients with hepatitis C virus (HCV), generally leads to lower incidence rates of HCV in people living with HIV (PLHIV).

A team, led by Daniela K. van Santen, PhD, Disease Elimination Program, Burnet Institute, assessed the changes in primary HCV incidence after DAA access in people living with HIV.

Treatment as Prevention

Better access to DAA could reduce the incidence rate of HCV through a “treatment as prevention” effect.

In the study, the investigators used pooled individual-level data from 6 cohorts from the International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC). Each of the 45,942 participants was followed up with after the first recorded negative HCV antibody test date. Follow up ended at the last negative antibody test or estimated infection data.

The follow-up was restricted to 2010-2019.

The investigators used segmented Poisson regression to model different trends across pre-, limited-, and broad-DAA access periods.

Incidence Rates

Overall, there were 2042 incident HCV infections over the course of 248,189 person-years. However, during the study period the pooled incidence rate decreased from 0.91 per 100 person-years in 2015 to 0.41 per 100 person-years in 2019.

The average incidence was similar during the limited-DAA access period (IRR, 0.98; 95% CI, 0.87-1.11) compared to the average pre-DAA period incidence (0.90 per 100 person-years). The average incidence was also 52% lower during the broad-DAA access period (RR, 0.48; 95% CI, 0.42-0.52) and annually decline by about 2% in the pre-DAA period.

There was an additional 9% annual decline in incidence during the limited-DAA access period (IRR, 0.91; 95% CI, 0.82-1.00), as well as a 20% further decline in the broad-DAA access period (IRR, 0.80; 95% CI, 0.73-0.89).

“Our findings suggest that broad DAA access has a TasP effect on primary HCV incidence among PLHIV,” the authors wrote.” Based on the initial years of DAA availability, the countries in the InCHEHC collaboration are on track to meet the World Health Organization's 80% HCV incidence reduction target for PLHIV by 2030.”

DAA Utilization

A recent analysis also looked at DAA in treating HCV and concluded that the treatment family is underutilized in health care.

A team, led by Vy H. Nguyen, BA, Division of Gastroenterology and Hepatology, Stanford University Medical Center, evaluated HCV treatment rates since the advent of direct-acting antivirals.

The treatment rate decreased from 64.8% to 61.2% after 2018. This was particularly true after 2019, where the treatment rate decreased to less than 60% (P <.001).

The results also show the number of patients with viremic HCV between April 2020 and March 2021 decreased to 496 from 2761 and 3258 the previous 2 years.

Patients receiving care from a gastroenterologist or infectious disease specialist with advanced care practitioners, including nurse practitioners, physician assistants or clinical nurse specialists were independently associated with a greater chance of DAA treatment (aOR, 1.64; 95% CI, 1.07-1.50).

However, patients with decompensated cirrhosis and/or hepatocellular carcinoma were 31% less likely to be receive any treatment compared to individuals without those conditions (aOR, 0.69; 95% CI, 0.54-0.90).

The study, “Treatment as prevention effect of direct-acting antivirals on primary hepatitis C virus incidence: Findings from a multinational cohort between 2010 and 2019,” was published online in eClinicalMedicine.