Taiwan has committed to achieving HCV elimination by 2025. HCV testing and antiviral treatments are reimbursed by the National Health Insurance. Interferon/ribavirin used to be the standard regimen of antiviral treatment and direct-acting antivirals (DAAs) were not reimbursed until 2017. Criteria for enrollment in HCV treatment program had been revised on an annual basis to lift the restrictions on access to HCV care and DAA treatment stepwise. Acute HCV infections were included in the treatment program in 2019. We aimed to examine the progress toward HCV microelimination among people living with HIV (PLWH) who had HCV viremia.
PLWH seeking care between 2013 and 2021 received HCV serological testing at least once annually. Those who tested HCV-seropositive at baseline or who received antiviral treatments with achievement of spontaneous clearance or sustained virological response (SVR) underwent HCV RNA testing at least once annually. Between 2019 and 2021, those with episodes of sexually transmitted infections, having achieved spontaneous clearance or (SVR), or elevated aminotransferases underwent HCV RNA testing every 12 weeks for 48 weeks. We estimated the annual incidence rate and prevalence of HCV viremia from 2013 to 2021.
During the 8-year study period, 4075 PLWH were included. The incidence rate of HCV viremia had increased from 29.86 per 1000 person-years of follow-up (PYFU) in 2013 to 53.97 per 1000 PYFU in 2015, which sustained until 2018 (50.49 per 1000 PYFU), when the incidence rates started to decrease to 28.99 per 1000 PYFU in 2020. The prevalence of HCV viremia had declined from 11.21% of PLWH tested in 2013 to 7.46% in 2016 (interferon/ribavirin era), and further decline from 7.87% in 2018 to 2.50% in 2021 (DAA era). Overall a significant decrease by 78% of HCV viremia was achieved (figure) between 2013 and 2021.
With the introduction of reimbursed HCV testing anti-HCV treatments, particularly DAAs, significant declines of HCV viremia were observed among PLWH who underwent regular testing in Taiwan.