The WHO global hepatitis C (HCV) elimination targets include diagnosing 90% and treating 80% of HCV infected individuals by 2030. We described the HCV cascade of care (CoC) for people living with HIV (PLHIV) across Europe to assess progress towards reaching these two targets.
HIV/HCV-coinfected participants in the EuroSIDA cohort under prospective follow-up at 1 October 2018 were described using a CoC with 3 diagnostic stages – anti-HCV positive, ever HCV RNA tested, currently HCV RNA positive; and 7 treatment stages – ever chronically infected (multiple imputation for persons with missing HCV RNA test data), ever diagnosed with chronic HCV, ever treated, completed treatment, sufficient follow-up available, follow-up HCV RNA available, cured. CoC were compared across five European regions and 20 countries enrolling >50 persons.
Of 5,080 anti-HCV positive persons, 4,609 (90.7%, 95% confidence interval (CI) 89.9-91.6) were ever HCV RNA tested (Figure 1A) and 24.3% of individuals (95% CI 21.9-26.7) were currently HCV RNA positive, with higher prevalence in Central-East and East (45.4% and 33.2%, respectively). Among all participating countries the proportion of currently HCV RNA positive was the highest in Estonia (62% of 160 anti-HCV positive) and lowest in Austria (4.8% of 124). An estimated 4,562 (89.8%, 95% CI 88.9-90.7) anti-HCV positive individuals have been ever chronically infected, of which 4,155 persons (90.1%, 95% CI 89.2-91.0) have been ever diagnosed with chronic HCV (Figure 1B). In Eastern Europe, 68.4% of chronic infections have ever been diagnosed, with >93% in the other four regions. Overall, 2,989 persons have ever been treated (65.5% of the ever chronically infected, 95% CI 63.8-67.2) and 2,186 individuals (47.9% of the ever chronically infected, 95% CI 45.8-50) were cured. Cure proportion ranged from 6.7% of 356 ever chronically infected in Belarus to 87.2% of 109 in Austria.
In all regions except Eastern Europe, >90% of anti-HCV positive PLHIV under follow-up at 1 October 2018 have been tested for HCV RNA. In South and Central-West, >80% ever chronically HCV infected PLHIV have ever received treatment. Overall, the proportion with cured HCV infection did not exceed 80% in any region with significant heterogeneity between countries. Increased access to affordable direct acting antivirals, particularly in Eastern Europe, is required to achieve HCV elimination by 2030 among PLHIV in Europe.
