@article{531432523dd54c4c9c7660a746c318c7,
title = "HCV micro-elimination in individuals with HIV in the Netherlands 4 years after universal access to direct-acting antivirals: a retrospective cohort study",
abstract = "Background: In the Netherlands, access to direct-acting antivirals (DAAs) against hepatitis C virus (HCV) has been unrestricted for chronic infection since 2015. We evaluated whether the nationwide incidence of HCV infections in individuals with HIV has changed since 2015. Methods: In this retrospective cohort study, data from the ATHENA cohort of people with HIV aged 18 years or older attending any of the 24 HIV treatment centres in the Netherlands between 2000 and 2019 were assessed. We used parametric proportional hazards models with a piecewise exponential survival function to model HCV primary infection and reinfection incidence per 1000 person-years. Findings: Of the 23 590 individuals without previous HCV infection, 1269 cases of HCV primary infection were documented (incidence 5·2 per 1000 person-years [95% CI 5·0–5·5]). The highest incidence was observed in men who have sex with men (MSM; 7·7 per 1000 person-years [7·3–8·2]) and was lower in people who inject drugs (PWID; 1·7 per 1000 person-years [0·7–4·1]) and other key populations (1·0 per 1000 person-years [0·8–1·2]). In MSM, incidence increased in 2007 to 14·3 per 1000 person-years and fluctuated between 8·7 and 13·0 per 1000 person-years from 2008 to 2015. In 2016, incidence declined to 6·1 cases per 1000 person-years and remained steady between 4·1 and 4·9 per 1000 person-years from 2017 to 2019. Of the 1866 individuals with a previous HCV infection, 274 reinfections were documented (incidence 26·9 per 1000 person-years [95% CI 23·9–30·3]). The highest incidence rate was observed in MSM (38·5 per 1000 person-years [33·9–43·7]) and was lower in PWID (10·9 per 1000 person-years [3·5–33·8]) and other key populations (8·9 per 1000 person-years [6·3–12·5]). In MSM, reinfection incidence fluctuated between 38·0 and 88·9 per 1000 person-years from 2006 to 2015, reaching 55·6 per 1000 person-years in 2015. In 2016, reinfection incidence declined to 41·4 per 1000 person-years, followed by further decreases to 24·4 per 1000 person-years in 2017 and 11·4 per 1000 person-years in 2019. Interpretation: The sharp decline in HCV incidence in MSM with HIV shortly after restrictions on DAAs were lifted suggests a treatment-as-prevention effect. HCV incidence was already low in PWID and other groups before unrestricted access. Ongoing HCV transmission is occurring in MSM, as illustrated by a declining but high rate of reinfection, stressing the need for additional preventive measures. Funding: Dutch Ministry of Health, Welfare, and Sport.",
author = "{ATHENA observational cohort} and Colette Smit and Anders Boyd and Rijnders, {Bart J.A.} and {van de Laar}, {Thijs J.W.} and Leyten, {Eliane M.} and Bierman, {Wouter F.} and Kees Brinkman and Claassen, {Mark A.A.} and {den Hollander}, Jan and Anne Boerekamps and Newsum, {Astrid M.} and Janke Schinkel and Maria Prins and Arends, {Joop E.} and {Op de Coul}, {Eline L.M.} and {van der Valk}, Marc and Peter Reiss and {van der Valk}, M. and Geerlings, {S. E.} and A. Goorhuis and Hovius, {J. W.} and B. Lempkes and J. Nellen and {van der Poll}, T. and Prins, {J. M.} and {van Vugt}, M. and Wiersinga, {W. J.} and Wit, {F. W.M.N.} and {van Duinen}, M. and {van Eden}, J. and A. Hazenberg and {van Hes}, {A. M.H.} and Pijnappel, {F. J.J.} and Smalhout, {S. Y.} and Weijsenfeld, {A. M.} and S. Jurriaans and Back, {N. K.T.} and Zaaijer, {H. L.} and B. Berkhout and Cornelissen, {M. T.E.} and Schinkel, {C. J.} and {van Agtmael}, {M. A.} and M. Bomers and Sigaloff, {K. C.E.} and {van Houdt}, R. and M. Jonges and B. Wintermans and M. Hoogewerf and W. Rozemeijer and M. Bakker and Wolthers, {K. C.} and Ang, {C. W.} and A. Reuwer and {van Nood}, E. and R. Renckens and M. Kok and J. Hoogerwerf and O. Richel and Stelma, {F. F.} and N. Langebeek and Lauw, {F. N.} and {van Wijk}, M. and Y. Stienstra and Bezemer, {D. O.} and {van Sighem}, {A. I.} and {van de Sande}, L. and M. Groters and M. Schoorl",
note = "Funding Information: BJAR reports grants from MSD and Gilead, outside the submitted work and is a member of advisory boards for MSD, Gilead, Pfizer, ViiV Healthcare, Jansen-Cilag, and Abbvie. WFB reports reimbursement of costs inclusion patient in industry-sponsored RCT from GSK and non-financial support from Janssen, all outside the submitted work. KB is an advisory board member for ViiV Healthcare, Gilead, MSD, and Janssen; and reports grants form ViiV Healthcare and Gilead. JS reports grants from Gilead Sciences, outside the submitted work. MP reports grants, personal fees, speakers fees and independent scientific support to their institution from Gilead Sciences, Roche, MSD, and Abbvie, all outside the submitted work. JEA reports fees paid to their institution from Gilead, Janssen-Cilag, Abbvie, Bristol-Myers Squibb, and MSD for advisory membership, all outside the submitted work. MvdV reports grants and personal fees from Abbvie, Gilead, Johnson & Johnson, MSD, and ViiV Healthcare, all outside the submitted work. PR reports grants from Gilead, ViiV Healthcare, and Merck & Co; and honoraria and is an advisory board member for Gilead Sciences, ViiV Healthcare, Merck & Co, and Teva Pharmaceutical Industries, all outside the submitted work. All other authors report no competing interests. Publisher Copyright: {\textcopyright} 2021 Elsevier Ltd Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",
year = "2021",
month = feb,
doi = "https://doi.org/10.1016/S2352-3018(20)30301-5",
language = "English",
volume = "8",
pages = "e96--e105",
journal = "The Lancet HIV",
issn = "2352-3018",
publisher = "Elsevier Limited",
number = "2",
}