The latest update of the Gesida HIV/HCV coinfection study confirms the downward trend, placing the rate of coinfected patients below 1%.
Sonia Moreno. Madrid
A study on the prevalence of HCV coinfection in people with HIV in Spain, conducted by Gesida, the AIDS Study Group of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), concludes that fewer and fewer people with HIV in Spain are also affected by a hepatitis C virus infection. Specifically, the study reveals a rate of 0.85%, 96.1% lower than in 2015.
This update, notes HIV expert Juan Berenguer , a scientist at the Gregorio Marañón Health Research Institute and lead co-author of the study, is the eighth since the first one in 2002. The second update of this study was carried out in 2009, and the remaining six between 2015 and 2021. The COVID-19 pandemic prevented its completion in 2020.
However, the robustness of the data provided by this Gesida research allows us to affirm that the micro-elimination strategy for hepatitis C in the HIV-positive population is getting closer.
'Simply spectacular'
“The data from the end of 2021 from the HIV/HCV coinfection prevalence study are simply spectacular and indicate that the long-awaited goal of HCV elimination among people with HIV is practically being achieved,” Juan Berenguer confirms to this media outlet.
The widespread access to direct-acting antivirals against HCV in Spain is "the main cause of the drastic decrease in the prevalence of active HCV infection in people with HIV" observed in this registry.
This is also reflected in the trend observed in the years following the launch of these treatments. At the end of 2015, hepatitis C virus infection in people with HIV reached a prevalence of 22.1%, while in 2019 it stood at 2.2%, that is, 90% less.
Even with these positive figures, the specialist clarifies that "in any case, we must not forget about HCV, nor lower our guard while there are people at risk of infection due to high-risk sexual practices, often associated with intravenous drug use."
And remember that “despite the achievements made, HCV has left a legacy because a significant proportion of people with HIV cured of hepatitis C had liver cirrhosis at the time of cure and will need to remain in hepatocellular carcinoma screening programs.”
Road to elimination
From the Alliance for the Elimination of Viral Hepatitis in Spain (Aehve), its coordinator Javier García-Samaniego tells DM that “the work done with people co-infected with HIV and HCV is precisely the path we must follow to eliminate hepatitis C in other vulnerable populations, where much progress has also been made since the implementation of the Strategic Plan for the approach to Hepatitis C in the NHS (PEAHC), but we still have not even recovered the pre-pandemic pace in populations such as injecting drug users (IDUs), who concentrate most of the virus reservoir.”
In contrast, the head of Hepatology at La Paz University Hospital in Madrid expresses his satisfaction with the progress of the #HepCityFree initiative , promoted by Aehve, in which the Spanish Association for the Study of the Liver (AEEH) participates, along with other scientific societies and patient associations committed to the goal of elimination, and which has the collaboration of the companies Gilead and Abbvie.
The first results of this initiative, launched in Seville (the first of 17 cities to join), were recently presented at the AEEH congress in Madrid. Thanks to the program, 283 cases of hepatitis C were detected and treatment began in Seville : 34 in addiction treatment centers, STI clinics, and among the homeless, and 249 after a review of data from health centers.
According to the authors of the study, the results of #HepCityFree in Seville demonstrate the effectiveness of regional and municipal coordination and collaboration with social and non-profit organizations, emphasizing that increasing the chances of detecting HCV outside of a health center and facilitating quick and easy access to treatment is key to achieving elimination in the most vulnerable groups.
Furthermore, seven of the cities participating in the initiative have already implemented the micro-elimination actions outlined in the program in centers serving vulnerable groups under municipal jurisdiction (immigrants, the homeless, drug users). These actions include reviewing medical records, telemedicine, training, and awareness campaigns, and have already led to the diagnosis and treatment of 3,600 people . “Engaging cities in the elimination of hepatitis C is feasible and viable, even though healthcare responsibilities lie with the autonomous communities,” the authors of this study conclude.