Spain is making dramatic progress
towards eliminating hepatitis C in people living with HIV because of widespread
use of direct-acting antivirals, Juan Berenguer of Hospital Gregorio
Marañón, Madrid, reported on Friday at the 16th European
AIDS Conference (EACS 2017)
in Milan.

Sampling patients at 43 clinics in
Spain, researchers found that the proportion of people living with HIV who have
chronic hepatitis C virus (HCV) infection has fallen dramatically since 2009, from approximately
one-third of all patients in care to 11.7% of all patients in late 2016. In
just one year, from late 2015 to late 2016, the prevalence of chronic hepatitis
C in people living with HIV fell by 47%, from 22% to 11.6%.

The Spanish health care system has been
providing direct-acting antiviral treatment for hepatitis C to everyone with F2
grade fibrosis or above since early 2016 and provides direct-acting antiviral treatment to anyone
who might transmit HCV, regardless of fibrosis stage.

The GeSIDA network of Spanish
researchers carried out a cross-sectional study to evaluate the effect of
improved treatment access on the prevalence of HCV co-infection in people with
HIV in Spain. They sampled patients from 43 HIV treatment centres in Spain in
proportion to their patient population, taking a random sample from each
clinic. The total population in care was 38,904 in October and November 2016
(the sample period) and the random sample comprised 1588 patients, of whom 35%
were men who have sex with men and 29.6% were people who had acquired HIV
through injecting drug use.

This sample was compared with previous
samples in 2002, 2009 and 2015.

Whereas 60.8% of those sampled had HCV
antibodies in 2002, this proportion had declined to 34.6% by 2016. Similarly,
the proportion with chronic HCV infection (HCV RNA positive) fell from 54% in
2002 to 34% in 2009 and 11.7% in 2016.

In part this can be explained by the
declining proportion of the sample who had acquired HIV through injecting drug
use: 55.2% in 2002, and 29.6% in 2016.

However, the study also found that the
proportion who had ever received HCV treatment rose from 23% in 2002, 48% in
2009, and 59.3% in 2015 to 74.7% in 2016. Of the 548 people who had HCV
antibodies in the 2016 sample, 292 (53.2%) had been cured of hepatitis C. Of
the remaining 186 people with chronic infection, 41 were undergoing treatment
at the time of the survey, suggesting that if 95% were cured, HCV RNA
prevalence could have been as low as 9.1%.