Hepatitis C Elimination in People With HIV Is Contingent on Closing Gaps in the HIV Continuum

Abstract

Abstract Background Bolstered by the high efficacy of hepatitis C virus (HCV) treatment, the World Health Organization has called for HCV elimination by 2030. People with HIV (PWH) have been identified as a population in which elimination should be prioritized. Methods We examined progress in HCV elimination through the HCV care continuum among patients infected with HIV/HCV receiving HIV care at Johns Hopkins Hospital in Baltimore, Maryland, United States. Patients with HIV care visits in at least 2 consecutive years were followed through December 15, 2018, for referral to HCV care, treatment initiation, and cure. Results Among 593 HIV/HCV-coinfected individuals, 547 (92%) were referred for HCV care, 517 (87%) were evaluated for HCV treatment, 457 (77%) were prescribed HCV treatment, 426 (72%) initiated treatment, and 370 (62%) achieved HCV cure. In multivariable analysis, advanced liver disease (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.17–1.88) remained significantly positively associated with HCV treatment initiation. Conversely, being insured by state Medicaid (HR, 0.75; 95% CI, 0.61–0.92), having an HIV RNA >400 copies/mL (HR, 0.29; 95% CI, 0.18–0.49), and having missed 1%–24% (HR, 0.72; 95% CI, 0.54–0.97), 25%–49% (HR, 0.66; 95% CI, 0.49–0.89), and ≥50% of HIV care visits (HR, 0.39; 95% CI, 0.25–0.60) were significantly negatively associated with HCV treatment initiation. Conclusions HCV infection can be eliminated in PWH. However, HCV elimination requires unrestricted access to HCV treatment and improved methods of retaining people in medical care.