HCV micro-elimination in individuals with HIV in the Netherlands 4 years after universal access to direct-acting antivirals: a retrospective cohort study

Background In the Netherlands, access to direct-acting antivirals (DAAs) against hepatitis C virus (HCV) has been unrestricted for chronic infection since 2015. We evaluated whether nationwide incidence of HCV infections in individuals with HIV changed Methods this retrospective cohort study, data from ATHENA people aged 18 years or older attending any 24 treatment centres Netherlands between 2000 and 2019 were assessed. used parametric proportional hazards models a piecewise exponential survival function model primary reinfection per 1000 person-years. Findings Of 23 590 without previous infection, 1269 cases documented (incidence 5·2 person-years [95% CI 5·0–5·5]). The highest was observed men who have sex (MSM; 7·7 [7·3–8·2]) lower inject drugs (PWID; 1·7 [0·7–4·1]) other key populations (1·0 [0·8–1·2]). MSM, increased 2007 14·3 fluctuated 8·7 13·0 2008 2016, declined 6·1 remained steady 4·1 4·9 2017 2019. 1866 274 reinfections 26·9 23·9–30·3]). rate MSM (38·5 [33·9–43·7]) PWID (10·9 [3·5–33·8]) (8·9 [6·3–12·5]). 38·0 88·9 2006 2015, reaching 55·6 41·4 person-years, followed by further decreases 24·4 11·4 Interpretation sharp decline shortly after restrictions on DAAs lifted suggests treatment-as-prevention effect. already low groups before access. Ongoing transmission is occurring as illustrated declining but high reinfection, stressing need additional preventive measures. Funding Dutch Ministry Health, Welfare, Sport.