Can HCV be eliminated among HIV-positive men who have sex with men in Berlin? A modeling analysis.

BACKGROUND: Despite high hepatitis C virus (HCV) treatment rates, HCV incidence among HIV-positive men who have sex with men (HIV+ MSM) in Germany rose prior to HCV direct-acting antivirals (DAAs). We model what intervention can achieve the World Health Organization (WHO) elimination target of 80% incidence reduction by 2030 among HIV+ MSM in Berlin.

METHODS: An HCV transmission model among HIV-diagnosed MSM was calibrated to Berlin (rising HCV incidence and high HCV testing/treatment). We modelled HCV incidence among HIV-diagnosed MSM in Berlin until 2030 (relative to 2015 WHO baseline) under scenarios of DAA scale-up with/without behavior change (among HIV-diagnosed MSM and/or all MSM).

RESULTS: Continuing current treatment rates will marginally reduce HCV incidence among HIV-diagnosed MSM in Berlin by 2030. Scaling-up DAAs to 100% within 3 months of diagnosis and 25%/year of previously diagnosed and untreated from 2018 could reduce incidence by 61% (2.5-97.5%Interval 55.4-66.7%) by 2030. The WHO target would likely be achieved by combining DAA scale-up with 40% HCV transmission risk reduction among HIV-diagnosed MSM and 20% transmission reduction from HIV-undiagnosed or negative MSM.

DISCUSSION: HCV elimination among HIV+ MSM in Berlin likely requires combining DAA scale-up with moderately effective behavioral interventions to reduce risk among all MSM.