Background
Hepatitis C virus (HCV) incidence is high among people with HIV (PWH) and people who inject drugs (PWID). Sexual transmission may also contribute to a higher HCV incidence in PWH, mainly among men who have sex with men (MSM). We report epidemiologic trends of incident HCV infection among PWH engaged in care in the US, stratified by HIV acquisition risk factors.
Methods
This retrospective cohort study used data from the CFAR Network of Integrated Clinical Systems from 1995-2023. Included PWH had a negative HCV antibody at first measurement (baseline) and any HCV test (HCV antibody or RNA) at least 12 months later. Incident HCV infection was defined as newly reactive HCV antibody or plasma HCV RNA. Follow up time was censored at first positive HCV test, or last observed negative HCV test. Crude incidence rates (IR) with 95% CI stratified by HIV risk group were calculated using survival methods. Calendar time trends were analyzed in three periods: 1995-2005 (interferon era), 2006-2014 (early direct-acting antiviral [DAA] era), and 2015-2023 (highly active DAA era). We calculated adjusted incidence rate ratios (aIRR) using Poisson regression to estimate the association of baseline sociodemographic factors and detectable HIV RNA with incident HCV.
Results
In sum, 20,917 PWH met study criteria, with median age 37 years, 81% male sex assigned at birth, 41% Black, 61% MSM, and 6.4% with PWID/MSM-PWID. There were 1,276 (6.1%) incident cases of HCV infection, overall IR 7.1 (CI 6.7-7.5) per 1000 person-years (py). Crude IR was highest among persons with PWID (IR 28.2 per 1000 py, CI 23.4-34.1) and MSM-PWID (IR 20.4 per 1000 py, CI 17.3-24.0), but stable across calendar periods. Crude IR was higher among MSM without IDU history (6.7 per 1000 py, CI 6.2-7.2) than heterosexual PWH (4.8 per 1000 py, CI 4.2-5.4). The crude IR increased from 3.5 (CI 2.7-4.6) per 1000 py in 1995-2005 to 7.6 (CI 6.9-8.3) per 1000 py in 2015-2023 among MSM without IDU. Calendar periods 2006-2014 (aIRR 1.3, CI 1.1-1.7) and 2015-2023 (aIRR 1.9, CI 1.4-2.6) and HIV risk category MSM without IDU (aIRR 1.3, CI 1.1-1.6) were independent risk factors for incident HCV.
Conclusions
HCV incidence increased more than two-fold in MSM without IDU history from 1995-2005 to 2015-2023; rates in PWID/MSM-PWID were stable over this period. Further study of time-varying covariates such as substance use, incident STIs, and HCV testing frequency that may account for the rising HCV incidence among MSM in the highly active DAA era is needed.
Table or Figure
