A systematic policy of test-and-treat cured 99% of men who
have sex with men with hepatitis C in the Swiss HIV Cohort in an 8-month period
and reduced the prevalence of hepatitis C by almost two-thirds, Dominique Braun
of the University Hospital, Zurich, reported at the 16th European
AIDS Conference (EACS 2017)
last week in Milan.

Dr Braun was presenting results of the Swiss HCVree trial, a
non-randomised study of hepatitis C virus (HCV) testing, treatment and behavioural counselling
designed to eliminate chronic HCV infection in men who have
sex with men with HIV/HCV co-infection in the Swiss HIV Cohort.

The Swiss HIV Cohort has seen a 20-fold increase in the
prevalence of HCV in men who have sex with men since 1996, with the greatest
increase occurring since 2008, in common with other western European countries.

Reducing onward transmission and prevalence of HCV requires
a reduction in the number of people with chronic HCV infection and a
reduction in risk behaviours. Chemsex – especially the use of drugs and sharing
of injecting equipment during sex – and group sex are strongly implicated in
the increase in hepatitis C in men who have sex with men.

In an 8-month period between October 2015 and May 2016 all men who have sex with men in the Swiss HCV Cohort were screened for active HCV infection. Screening
identified 177 men with chronic HCV infection (4.8%) of which 147 had been
diagnosed previously. Thirty new and previously undiagnosed HCV infections were
diagnosed as a result of the screening exercise.

All men with genotype 1 or 4 infection were offered
immediate treatment with a course of grazoprevir/elbasvir (Zepatier) for 12 or 16 weeks depending
on baseline resistance, with additional ribavirin for all genotype 1a and 4
patients with previous experience of pegylated interferon and ribavirin, for previously
untreated genotype 1a patients with baseline NS5A resistance mutations and
genotype 1b patients with prior HCV protease inhibitor experience.

Of the 177 people diagnosed with chronic HCV infection,
122 took part in the study (34 received treatment elsewhere, 11 had a genotype
other than 1 or 4, 6 had contraindications for treatment and the remainder were
either lost to follow-up or unwilling to take part in the study).

Men who joined the trial had a median age of 46 years, 88%
were white and all but one was taking antiretroviral therapy. Participants had
been diagnosed with HCV a median of three years before joining the study and
79% had F0-F1 stage fibrosis, indicating little liver damage since infection.
Six per cent had F3-F4 stage fibrosis.

The predominant genotypes were 1a (67%) and 4 (26%), with 7%
having genotype 1b infection. HCV RNA was relatively low at baseline (865,279
IE/ml).

All participants except one achieved a sustained virologic response
and was cured of hepatitis C infection. The exception was a previously
untreated man with genotype 4 infection who experienced viral rebound after
treatment.

Treatment was well tolerated with no serious drug-related
adverse events. Drug-related adverse events were reported in 29% of
participants and were predominantly fatigue, diarrhoea, nausea and itching.