Background
Men who have sex with men (MSM) on HIV pre-exposure prophylaxis (PrEP) have an increased risk of hepatitis C virus (HCV) infection. We assessed the impact of a test-and-treat campaign using HCV nucleic acid (NAT) and core antigen (cAg) testing in reducing the HCV incidence among MSM in the French ANRS PREVENIR study.
Methods
The ANRS PREVENIR study, launched in 2017, is an ongoing prospective cohort study of PrEP users in the Paris region, where participants are annually tested for HCV antibodies. From January 2020, all participants were offered HCV NAT and Ag testing in an initial 3-month campaign extended to June 2021 due to the COVID-19 pandemic. All participants with positive HCV NAT were immediately treated by direct-acting antiviral (DAA). We compared HCV incidence (95% confidence interval) and time to treatment initiation during the testing campaign (January 2020-June 2021) with the pre-campaign (May 2017–December 2019) and post-campaign (July 2021–May 2024) periods.
Results
From May 2017 to May 2024, 3050 participants contributed to the pre-campaign period, 2286 to the testing campaign, and 1824 to the post-campaign period, for a total of 4184, 2960, and 3709 person-years of follow-up per period, respectively. Most were MSM (98%), median age 36, and 14% reported chemsex. During the HCV testing campaign, 1567/2286 (69%) of participants were tested with HCV NAT, 1387/2286 (61%) with cAg, and 1578/2286 (69%) with HCV serology. HCV incidence significantly declined over the study periods: 7.9 (5.4, 11.1), 5.1 (2.8, 8.4), and 3.0 (1.5, 5.3) per 1000 person-years, pre-, during, and post-campaign, respectively (P=0.01). Among the 59 incident HCV infections (including 3 reinfections) reported during the study, 4 of the 15 diagnosed during the testing campaign were only detected by NAT. Of the 59 HCV infections, 50 (85%) were treated with DAA (48 cured, 2 unknown outcomes), 8 (14%) cleared without treatment, and 1 had missing treatment data. The median time from HCV diagnosis to DAA initiation was 47, 30, and 15 days during the pre-campaign, campaign, and post-campaign periods, respectively (Logrank P=0.06).
Conclusions
We observed a significant reduction in HCV incidence among MSM using PrEP following an HCV test and treat campaign. Additional factors, such as concurrent epidemics (COVID-19, monkeypox), changes in sexual behavior, and new recommendations for diagnosis and treatment of acute HCV infection in MSM, may also have contributed to this trend.
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