HCV Cascade of Care in HIV/HCV Co-Infected Individuals: Missed Opportunities for Micro-Elimination

• Published in: Viruses Vol. 16; no. 6; p. 885
• Main Authors: Thomadakis, Christos, Basoulis, Dimitrios, Tsachouridou, Olga, Protopapas, Konstantinos, Paparizos, Vasilios, Astriti, Myrto, Chini, Maria, Chrysos, Georgios, Marangos, Markos, Panagopoulos, Periklis, Kofteridis, Diamantis, Sambatakou, Helen, Mastrogianni, Elpida, Panatzis, Nikos, Pechlivanidou, Evmorfia, Psichοgiou, Mina, Touloumi, Giota
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 30-05-2024; MDPI
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Antiviral agents; Antiviral Agents - therapeutic use; Bioethics; cascade of care (COC); CD4 antigen; Clinics; Cohort analysis; Cohort Studies; Coinfection - drug therapy; Coinfection - virology; Collaboration; Comorbidity; DAAs; Drug therapy; Epidemics; Epidemiology; Female; Greece - epidemiology; HCV micro-elimination; Hepacivirus - drug effects; Hepatitis C; Hepatitis C - complications; Hepatitis C - drug therapy; Hepatitis C - virology; Hepatitis C, Chronic - complications; Hepatitis C, Chronic - drug therapy; Hepatitis C, Chronic - virology; HIV; HIV infection; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - virology; HIV/HCV co-infection; Homosexuality, Male; Human immunodeficiency virus; Humans; Infections; Male; Middle Aged; missed opportunities; Population; Regression analysis; Risk groups; Sexual and Gender Minorities; Statistics; Sustained Virologic Response; Tumor necrosis factor-TNF; Greece; DAAs; HIV/HCV co-infection; cascade of care (COC); missed opportunities; HCV micro-elimination
• ISSN: 1999-4915; 1999-4915
• DOI: 10.3390/v16060885

People living with HIV-HCV co-infection comprise a target group for HCV-micro-elimination. We conducted an HCV cascade of care (CoC) for HIV-HCV co-infected individuals living in Greece and investigated factors associated with different HCV-CoC stages. We analyzed data from 1213 participants from the Athens Multicenter AIDS Cohort Study. A seven-stage CoC, overall and by subgroup (people who inject drugs (PWID), men having sex with men (MSM), men having sex with women (MSW), and migrants], was constructed, spanning from HCV diagnosis to sustained virologic response (SVR). Logistic/Cox regression models were employed to identify factors associated with passing through each CoC step. Among 1213 anti-HCV-positive individuals, 9.2% died before direct-acting antiviral (DAA) availability. PWID exhibited higher mortality rates than MSM. Of 1101 survivors, 72.2% remained in care and underwent HCV-RNA testing. Migrants and PWID showed the lowest retention rates. HCV-RNA was available for 79.2% of those in care, with 77.8% diagnosed with chronic HCV. Subsequently, 71% initiated DAAs, with individuals with very low CD4 counts (<100 cells/μL) exhibiting lower odds of DAA initiation. SVR testing was available for 203 individuals, with 85.7% achieving SVR. The SVR rates did not differ across risk groups. In 2023, significant gaps and between-group differences persisted in HCV-CoC among HIV-HCV co-infected individuals in Greece.