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Moving Towards HCV Elimination Among People Living with HIV in Australia: Analysis of the CEASE Prospective Cohort Study

36 Pages Posted: 22 Oct 2018

See all articles by Marianne Martinello

Marianne Martinello

University of New South Wales (UNSW) - Kirby Institute; University of New South Wales (UNSW) - St Vincent’s Hospital; South Western Sydney Local Health District - Blacktown & Mount Druitt Hospital

Jasmine Yee

University of New South Wales (UNSW) - Kirby Institute

Sofia R. Bartlett

University of New South Wales (UNSW) - Kirby Institute

Phillip Read

Government of New South Wales - Kirketon Road Centre

David Baker

East Sydney Doctors

Jeffrey Post

Government of New South Wales - The Albion Centre

Robert Finlayson

Taylor Square Private Clinic

Mark Bloch

Holdsworth House Medical Practice

Joseph Doyle

Burnet Institute

David Shaw

Royal Adelaide Hospital

Diane Rowling

Brisbane Sexual Health Clinic

Nicholas Doong

Dr. N Doong

Eva Jackson

Government of New South Wales - Blue Mountains Sexual Health and HIV Clinic

Margaret Hellard

Burnet Institute; Alfred Hospital

Kathy Petoumenos

University of New South Wales (UNSW) - Kirby Institute

Lanni Lin

University of New South Wales (UNSW) - Kirby Institute

Philippa Marks

University of New South Wales (UNSW) - Kirby Institute

Tanya Applegate

University of New South Wales (UNSW) - Kirby Institute

Gregory J. Dore

University of New South Wales (UNSW) - Kirby Institute

Gail V. Matthews

University of New South Wales (UNSW) - Kirby Institute; University of New South Wales (UNSW) - St Vincent’s Hospital

More...

Abstract

Background: HCV elimination among people living with HIV may be feasible in Australia, given unrestricted access to direct-acting antiviral (DAA) therapy (from March 2016). Our aim was to evaluate HCV treatment uptake, outcome, and HCV RNA prevalence among HIV/HCV co-infected adults in Australia following the availability of DAA therapy.    

Methods: The Control and Elimination of HCV from HIV-infected individuals within Australia (CEASE) prospective cohort study enrolled adults with HIV and current (HCV RNA positive) or past (anti-HCV antibody positive, HCV RNA negative) HCV infection from 14 primary and tertiary clinics. Cumulative and annual HCV treatment uptake, outcome, and HCV RNA prevalence was evaluated, with follow up through May 2018 (median follow-up: 2.63 years, IQR 1.96, 3.20). Factors associated with DAA uptake were analysed using Cox regression.    

Findings: Between July 2014 and March 2017, 402 HIV/HCV antibody-positive participants were enrolled (95% male [80% gay and bisexual men], 13% cirrhosis, 79% history of injecting drug use [39% current injecting]). Cumulative HCV treatment uptake among those ever eligible was 91% (336/371). Annual HCV treatment uptake increased from 7% and 11% per year in 2014 and 2015, to 80% and 35% per year in 2016 and 2017, respectively. HCV viraemic prevalence declined from 82% in 2014 to 8% in 2018.    

Interpretation: High uptake and effectiveness of unrestricted government-subsidised DAA therapy has permitted rapid treatment scale-up, with a dramatic reduction in HCV infection burden among people living with HIV in Australia, suggesting that elimination within this population is feasible.  

Clinical Trial Number: The study was registered with ClinicalTrials.gov (NCT02102451).

Funding Statement: The Kirby Institute is funded by the Australian Government Department of Health and Ageing. The views expressed in this publication do not necessarily represent the position of the Australian Government. Research reported in this publication was supported by Gilead Sciences Inc as an investigator-initiated study. The content is solely the responsibility of the authors.

Declaration of Interests: None of the authors had commercial relationships that might pose a conflict of interest in connection with this manuscript.

Ethics Approval Statement: All study participants provided written informed consent before study procedures. The study protocol was approved by St Vincent’s Hospital, Sydney Human Research Ethics Committee (primary study committee) and was conducted according to the Declaration of Helsinki and International Conference on Harmonization Good Clinical Practice (ICH/GCP) guidelines and local regulatory requirements.

Keywords: HCV; HIV; Elimination; Gay and Bisexual Men; Treatment as Prevention

Suggested Citation

Martinello, Marianne and Yee, Jasmine and Bartlett, Sofia R. and Read, Phillip and Baker, David and Post, Jeffrey and Finlayson, Robert and Bloch, Mark and Doyle, Joseph and Shaw, David and Rowling, Diane and Doong, Nicholas and Jackson, Eva and Hellard, Margaret and Petoumenos, Kathy and Lin, Lanni and Marks, Philippa and Applegate, Tanya and Dore, Gregory J. and Matthews, Gail V., Moving Towards HCV Elimination Among People Living with HIV in Australia: Analysis of the CEASE Prospective Cohort Study (October 17, 2018). Available at SSRN: https://ssrn.com/abstract=3269607

Marianne Martinello (Contact Author)

University of New South Wales (UNSW) - Kirby Institute ( email )

Sydney
Australia

University of New South Wales (UNSW) - St Vincent’s Hospital ( email )

390 Victoria St
Darlinghurst, Sydney NSW 2010
Australia

South Western Sydney Local Health District - Blacktown & Mount Druitt Hospital ( email )

Blacktown
Australia

Jasmine Yee

University of New South Wales (UNSW) - Kirby Institute

Sydney
Australia

Sofia R. Bartlett

University of New South Wales (UNSW) - Kirby Institute

Sydney
Australia

Phillip Read

Government of New South Wales - Kirketon Road Centre

100 Victoria Street Kings Cross
Potts Point
Australia

David Baker

East Sydney Doctors

102 Burton Street
Darlinghurst
Australia

Jeffrey Post

Government of New South Wales - The Albion Centre

150 Albion St
Surry Hills, NSW 2010
Australia

Robert Finlayson

Taylor Square Private Clinic

393 Bourke Street
Darlinghurst, NSW 2010
Australia

Mark Bloch

Holdsworth House Medical Practice

Level 3, 26 College St.
Sydney, NSW 2010
Australia

Joseph Doyle

Burnet Institute

85 Commercial Road
Melbourne, VIC, 3004
Australia

David Shaw

Royal Adelaide Hospital

Port Rd
Adelaide SA 5000
Australia

Diane Rowling

Brisbane Sexual Health Clinic

Brisbane, Queensland
Australia

Nicholas Doong

Dr. N Doong

26 King St.
Enfield, NSW 2136
Australia

Eva Jackson

Government of New South Wales - Blue Mountains Sexual Health and HIV Clinic

Australia

Margaret Hellard

Burnet Institute

85 Commercial Road
Melbourne, VIC, 3004
Australia

Alfred Hospital

Melbourne
Australia

Kathy Petoumenos

University of New South Wales (UNSW) - Kirby Institute

Sydney
Australia

Lanni Lin

University of New South Wales (UNSW) - Kirby Institute

Sydney
Australia

Philippa Marks

University of New South Wales (UNSW) - Kirby Institute

Sydney
Australia

Tanya Applegate

University of New South Wales (UNSW) - Kirby Institute

Sydney
Australia

Gregory J. Dore

University of New South Wales (UNSW) - Kirby Institute

Sydney
Australia

Gail V. Matthews

University of New South Wales (UNSW) - Kirby Institute

Sydney
Australia

University of New South Wales (UNSW) - St Vincent’s Hospital

390 Victoria St
Darlinghurst, Sydney NSW 2010
Australia

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