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Modeling HIV-HCV coinfection epidemiology in the direct-acting antiviral era: the road to elimination

Victor Virlogeux 1, 2, 3 Fabien Zoulim 2, 1, 3 Pascal Pugliese 4 Isabelle Poizot-Martin 5, 6 Marc-Antoine Valantin 7, 8 Lise Cuzin 9, 10 Jacques Reynes 11, 12 Eric Billaud 13 Thomas Huleux 14 Firouzé Bani-Sadr 15, 16 David Rey 17 Anne Frésard 18 Christine Jacomet 19 Claudine Duvivier 20, 21 Antoine Cheret 21, 22 Laurent Hustache-Mathieu 23 Bruno Hoen 24, 25 André Cabié 26, 27, 25 Laurent Cotte 28, 3, *
* Corresponding author
Abstract : Background: HCV treatment uptake has drastically increased in HIV-HCV coinfected patients in France since direct-acting antiviral (DAA) treatment approval, resulting in HCV cure in 63% of all HIV-HCV patients by the end of 2015. We investigated the impact of scaling-up DAA on HCV prevalence in the whole HIV population and in various risk groups over the next 10 years in France using a transmission dynamic compartmental model. Methods: The model was based on epidemiological data from the French Dat’AIDS cohort. Eight risk groups were considered, including high-risk (HR) and low-risk (LR) men who have sex with men (MSM) and male/female heterosexuals, intra-venous drug users, or patients from other risk groups. The model was calibrated on prevalence and incidence data observed in the cohort between 2012 and 2015. Results: On January 1, 2016, 156,811 patients were registered as infected with HIV in France (24,900 undiagnosed patients) of whom 7938 (5.1%) had detectable HCV-RNA (722 undiagnosed patients). Assuming a treatment coverage (TC) rate of 30%/year (i.e., the observed rate in 2015), model projections showed that HCV prevalence among HIV patients is expected to drop to 0.81% in 2026. Sub-analyses showed a similar decrease of HIV-HCV prevalence in most risk groups, including LR MSM. Due to higher infection and reinfection rates, predicted prevalence in HR MSM remained stable from 6.96% in 2016 to 6.34% in 2026. Increasing annual TC rate in HR MSM to 50/70% would decrease HCV prevalence in this group to 2.35/1.25% in 2026. With a 30% TC rate, undiagnosed patients would account for 34% of HCV infections in 2026. Conclusions: Our model suggests that DAA could nearly eliminate coinfection in France within 10 years for most risk groups, including LR MSM. Elimination in HR MSM will require increased TC.
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Victor Virlogeux, Fabien Zoulim, Pascal Pugliese, Isabelle Poizot-Martin, Marc-Antoine Valantin, et al.. Modeling HIV-HCV coinfection epidemiology in the direct-acting antiviral era: the road to elimination. BMC Medicine, BioMed Central, 2017, 15 (1), pp.217. ⟨10.1186/s12916-017-0979-1⟩. ⟨inserm-01685739⟩

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