BACKGROUND: Following the introduction of direct-acting antiviral therapy in 2013, WHO launched the first Global Health Sector Strategy on Viral Hepatitis. We describe a hepatitis C virus (HCV) cascade of care in people with HIV (PWH) across Europe in terms of reaching the WHO elimination targets of diagnosing 90% and treating 80% of HCV-infected individuals. METHODS: HIV/HCV-coinfected participants in the EuroSIDA cohort under prospective follow-up at October 1, 2019, were described using a nine-stage cascade of care. Care cascades were constructed across Europe, on a regional (n = 5) and country (n = 21) level. RESULTS: Of 4773 anti-HCV positive PWH, 4446 [93.1%, 95% confidence interval (CI) 92.4-93.9)] were ever tested for HCV RNA, and 19.0% (95% CI 16.4-21.6) were currently HCV RNA positive, with the highest prevalence in Eastern and Central-Eastern Europe (33.7 and 29.6%, respectively). In Eastern Europe, 78.1% of the estimated number of chronic infections have been diagnosed, whereas this proportion was above 95% in the other four regions. Overall, 3116 persons have ever started treatment (72.5% of the ever chronically infected, 95% CI 70.9-74.0) and 2404 individuals (55.9% of the ever chronically infected, 95% CI 53.9-57.9) were cured. Cure proportion ranged from 11.2% in Belarus to 87.2% in Austria. CONCLUSION: In all regions except Eastern Europe, more than 90% of the study participants have been tested for HCV-RNA. In Southern and Central-Western regions, more than 80% ever chronically HCV-infected PWH received treatment. The proportion with cured HCV infection did not exceed 80% in any region, with significant heterogeneity between countries. SUMMARY: In a pan-European cohort of PWH, all regions except Eastern Europe achieved the WHO target of diagnosing 90% of chronic HCV infections, while the target of treating 80% of eligible persons was achieved in none of the five regions.

Barcelona Institute for Global Health Hospital Clínic University of Barcelona Barcelona Spain

Belarusian State Medical University Minsk Belarus

Centre for Clinical Research Epidemiology Modelling and Evaluation Institute for Global Health UCL London UK

Centre of Excellence for Health Immunity and Infections Rigshospitalet Copenhagen Denmark

Charles University Prague and Na Bulovce Hospital Prague Czech Republic

Department for Rheumatology and Immunology Hannover Medical School Hannover Germany

Department of Infectious Diseases Bern University Hospital University of Bern Switzerland

Department of Infectious Diseases Odense University Hospital Odense Denmark

Department of Infectious Diseases Venhälsan Södersjukhuset Stockholm Sweden

Department of Infectious Tropical Diseases and Immune Deficiency Pomeranian Medical University Szczecin Poland

Department of Medicine University Hospital Bonn Bonn Germany

Hospital de Egas Moniz Lisbon Portugal

Hospital Universitario de Alava Vitoria Gasteiz Spain

Royal London Hospital London UK

Samara State Medical University Samara Russia

Servicio Enfermedades Infecciosas Hospital Universitario Ramón y Cajal Madrid Spain

Sjællands Universitetshospital Roskilde Denmark

Sorbonne Université IPLESP Inserm UMR S1136 AP HP Paris France

Vilnius University Faculty of Medicine Department of Infectious Diseases and Dermatovenerology Vilnius Lithuania

See more in PubMed

Zoratti MJ, Siddiqua A, Morassut RE, Zeraatkar D, Chou R, van Holten J, et al. Pangenotypic direct acting antivirals for the treatment of chronic hepatitis C virus infection: a systematic literature review and meta-analysis . EClinicalMedicine 2020; 18:100237.

Zheng Y-X, Ma S-J, Xiong Y-H, Fan X-G. Efficacy and safety of direct acting antiviral regimens for hepatitis C virus and human immunodeficiency virus co-infection: systematic review and network meta-analysis . J Gastroenterol Hepatol 2020; 35:1477–1487.

World Health Organization. Global health sector strategy on viral hepatitis 2016–2021. Towards ending viral hepatitis . In Geneva: World Health Organization; 2016.

Ganesan M, Poluektova LY, Kharbanda KK, Osna NA. Human immunodeficiency virus and hepatotropic viruses co-morbidities as the inducers of liver injury progression . World J Gastroenterol 2019; 25:398–410.

Cooke GS, Andrieux-Meyer I, Applegate TL, Atun R, Burry JR, Cheinquer H, et al. Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission . Lancet Gastroenterol Hepatol 2019; 4:135–184.

Palayew A, Razavi H, Hutchinson SJ, Cooke GS, Lazarus JV. Do the most heavily burdened countries have the right policies to eliminate viral hepatitis B and C? . Lancet Gastroenterol Hepatol 2020; 5:948–953.

Papatheodoridis GV, Hatzakis A, Cholongitas E, Baptista-Leite R, Baskozos I, Chhatwal J, et al. Hepatitis C: the beginning of the end—key elements for successful European and national strategies to eliminate HCV in Europe . J Viral Hepatitis 2018; 25:6–17.

Smith S, Harmanci H, Hutin Y, Hess S, Bulterys M, Peck R, et al. Global progress on the elimination of viral hepatitis as a major public health threat: an analysis of WHO Member State responses 2017 . JHEP Rep 2019; 1:81–89.

Peters L, Laut K, Resnati C, Del Campo S, Leen C, Falconer K, et al. Uptake of hepatitis C virus treatment in HIV/hepatitis C virus-coinfected patients across Europe in the era of direct-acting antivirals . AIDS 2018; 32:1995–2004.

Joint United Nations Programme on HIV/AIDS (UNAIDS). 90–90–90: an ambitious treatment target to help end the AIDS epidemic . Geneva: Joint United Nationas Programme on HIV/AIDS (UNAIDS); 2014.

Safreed-Harmon K, Blach S, Aleman S, Bollerup S, Cooke G, Dalgard O, et al. The Consensus Hepatitis C Cascade of Care: standardized reporting to monitor progress toward elimination . Clin Infect Dis 2019; 69:2218–2227.

Laut K, Kirk O, Rockstroh J, Phillips A, Ledergerber B, Gatell J, et al. The EuroSIDA study: 25 years of scientific achievements . HIV Medicine 2020; 21:71–83.

CHIP (Centre of Excellence for Health, Immunity and Infections). EuroSIDA study. Available at: https://chip.dk/Research/Studies/EuroSIDA [Accessed October 2021].

Amele S, Peters L, Sluzhynska M, Yakovlev A, Scherrer A, Domingo P, et al. Establishing a hepatitis C continuum of care among HIV/hepatitis C virus-coinfected individuals in EuroSIDA . HIV Med 2019; 20:264–273.

World Health Organization, Regional Office for Europe. List of the WHO European countries. Available at: https://www.euro.who.int/en/countries [Accessed November 2021].

Mocroft A, Lundgren J, Gerstoft J, Rasmussen LD, Bhagani S, Aho I, et al. Clinical outcomes in persons coinfected with human immunodeficiency virus and hepatitis C virus: impact of hepatitis C virus treatment . Clin Infect Dis 2020; 70:2131–2140.

Grint D, Peters L, Rockstroh JK, Rakmanova A, Trofimova T, Lacombe K, et al. Liver-related death among HIV/hepatitis C virus-co-infected individuals: implications for the era of directly acting antivirals . AIDS 2015; 29:1205–1215.

Rubin DB. Multiple imputation for nonresponse in surveys . Hoboken, NJ: John Wiley & Sons Inc.; 1987.

Giandinoto J-A, Stephenson J, Edward K-L. General hospital health professionals’ attitudes and perceived dangerousness towards patients with comorbid mental and physical health conditions: systematic review and meta-analysis . Int J Ment Health Nurs 2018; 27:942–955.

Chan PY, Joseph MA, Des Jarlais DC, Uusküla A. Perceived effectiveness of antiretroviral therapy, self-rated health and treatment adherence among HIV-positive people who inject drugs in Estonia . Int J STD AIDS 2018; 29:13–22.

Hylton E, Wirtz AL, Zelaya CE, Latkin C, Peryshkina A, Mogilnyi V, et al. Sexual identity, stigma, and depression: the role of the ‘Antigay Propaganda Law’ in mental health among men who have sex with men in Moscow, Russia . J Urban Health 2017; 94:319–329.

Santos G-M, Makofane K, Arreola S, Do T, Ayala G. Reductions in access to HIV prevention and care services are associated with arrest and convictions in a global survey of men who have sex with men . Sex Transm Infect 2017; 93:62–64.

Stojisavljevic S, Djikanovic B, Matejic B. ’The Devil has entered you’: a qualitative study of men who have sex with men (MSM) and the stigma and discrimination they experience from healthcare professionals and the general community in Bosnia and Herzegovina . PLoS One 2017; 12:e0179101.

Roberson JL, Kan VL. Hepatitis C virus continuum of care in the interferon and direct-acting agent eras among HIV-coinfected patients . AIDS Res Hum Retroviruses 2017; 33:405–406.

Yehia BR, Schranz AJ, Umscheid CA, Lo Re V. The treatment cascade for chronic hepatitis C virus infection in the United States: a systematic review and meta-analysis . PLoS One 2014; 9:e101554.

Selfridge M, Cunningham EB, Milne R, Drost A, Barnett T, Lundgren K, et al. Direct-acting antiviral treatment for hepatitis C, reinfection and mortality among people attending an inner-city community health centre in Victoria, Canada . Int J Drug Policy 2019; 72:106–113.

Razavi H, Gonzalez YS, Yuen C, Cornberg M. Global timing of hepatitis C virus elimination in high-income countries . Liver Int 2020; 40:522–529.

Colombo MG, Musabaev EI, Ismailov UY, Zaytsev IA, Nersesov AV, Anastasiy IA, et al. Consensus on management of hepatitis C virus infection in resource-limited Ukraine and Commonwealth of Independent States regions . World J Gastroenterol 2019; 25:3897–3919.

Averhoff F, Lazarus JV, Sergeenko D, Colombo M, Gamkrelidze A, Tsertsvadze T, et al. Excellence in viral hepatitis elimination – lessons from Georgia . J Hepatol 2019; 71:645–647.

Béguelin C, Suter A, Bernasconi E, Fehr J, Kovari H, Bucher HC, et al. Trends in HCV treatment uptake, efficacy and impact on liver fibrosis in the Swiss HIV Cohort Study . Liver Int 2018; 38:424–431.

Boerekamps A, Newsum AM, Smit C, Arends JE, Richter C, Reiss P, et al. High treatment uptake in human immunodeficiency virus/hepatitis C virus–coinfected patients after unrestricted access to direct-acting antivirals in the Netherlands . Clin Infect Dis 2018; 66:1352–1359.

Rappold M, Rieger A, Gisinger M, Sarcletti M, Schmied B, Geit M, et al . The hepatitis C continuum of care among HIV infected individuals in Austria [Abstract #596] . Conference on Retroviruses and Opportunistic Infections (CROI): 2018 ; Boston, Massachusetts; 2018.

Ingiliz P, Wehmeyer MH, Boesecke C, Schulze Zur Wiesch J, Schewe K, Lutz T, et al. Reinfection with the hepatitis C virus in men who have sex with men after successful treatment with direct-acting antivirals in Germany: current incidence rates, compared with rates during the interferon era . Clin Infect Dis 2020; 71:1248–1254.