HCV Microelimination Program and Patient Trajectories After HCV Cure in an Outpatient HIV Clinical Unit

Background: Treatment recommendations for hepatitis C now make no distinction between HIV/HCV-coinfected and HCV-monoinfected patients. The largest challenge remained lack of effective models to eliminate HCV in people living with HIV. We report the results of a microelimination program evaluating the possibility of eradicating HCV infection in an HIV-outpatient clinical unit within 12 months.   Methods:  This HCV-microelimination program began in February 2016 in an unit following approximately 1000 HIV-infected patients and combined screening and therapeutic components according to the French guidelines for coinfection. A substudy evaluating the impact of HCV cure on different health outcomes was conducted through self-administered questionnaires and using generalized mixed models.   Findings: Among 601 patients eligible for HCV serological testing, 445 (74%) were evaluated, and two cases of acute HCV infection were diagnosed. Among the 151 patients eligible for HCV RNA quantification, 119 (79%) were evaluated, and one case of reinfection with HCV was diagnosed. Among the 110 patients eligible for DAA treatment, 51 (46·4%) patients initiated treatment within the 12 months program, and 35 (31·8%) after. Sustained virologic response (SVR) rate was 96·1%, and two treatment failed. At least one self-reported symptom was declared by 72·5% (n=29) of patients. Positive impact of HCV cure was observed on various markers of physical and mental health as well as on health habits. Interpretation: Our program should be considered as a proof of concept, which confirmed the feasibility of a HCV-microelimination program at the scale of an HIV clinical unit. However, 12 months were not sufficient to achieve our objective despite the specific organization.   Funding Statement: This study was conducted with a grant of Gilead sciences. The sponsors of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the report.   Declaration of Interests: I Poizot-Martin: reports personal fees from Gilead Sciences, MSD, for consultancies, and support from Gilead sciences, ViiVhealthcare for travel/accommodation/meeting expenses, outside the submitted work. H Laroche: reports personal fees from GILEAD/VIIV/Pfizer for consultancies, and support from ViiV/Gilead/Pfizer/MSD for travel/accommodation/meeting expenses, outside the submitted work. S Bregigeon: reports personal fees from Janssen for consultancies, and support from MSD, ViiV for travel/accommodation/meeting expenses, outside the submitted work. C Solas: reports personal fees from Viiv, Abbvie, Gilead for consultancies, and support from MSD, Viiv, Gilead for travel/accommodation/meeting expenses, outside the submitted work. C Lions, O Zaegel-Faucher, E Ressiot, C Tamalet, MA Pieve, AS Ritleng, C Debreux, A Ivanova, Obry-Roguet, P Carrieri, P Geneau De Lamarliere: no conflicts of interest Ethics Approval Statement: This research program was approved by the Ethical Committee CCP-Sud-mediterranee-1 Marseille, France, number 2015-A01913-46.