title: Can Hepatitis C Virus (HCV) Direct-Acting Antiviral Treatment as Prevention Reverse the HCV Epidemic Among Men Who Have Sex With Men in the United Kingdom? Epidemiological and Modeling Insights.
abstract: BACKGROUND
  We report on the hepatitis C virus (HCV) epidemic among human immunodeficiency virus (HIV)-positive men who have sex with men (MSM) in the United Kingdom and model its trajectory with or without scaled-up HCV direct-acting antivirals (DAAs).
  
  
  METHODS
  A dynamic HCV transmission model among HIV-diagnosed MSM in the United Kingdom was calibrated to HCV prevalence (antibody [Ab] or RNA positive), incidence, and treatment from 2004 to 2011 among HIV-diagnosed MSM in the UK Collaborative HIV Cohort (UK CHIC). The epidemic was projected with current or scaled-up HCV treatment, with or without a 20% behavioral risk reduction.
  
  
  RESULTS
  HCV prevalence among HIV-positive MSM in UK CHIC increased from 7.3% in 2004 to 9.9% in 2011, whereas primary incidence was flat (1.02-1.38 per 100 person-years). Over the next decade, modeling suggests 94% of infections are attributable to high-risk individuals, comprising 7% of the population. Without treatment, HCV chronic prevalence could have been 38% higher in 2015 (11.9% vs 8.6%). With current treatment and sustained virological response rates (status quo), chronic prevalence is likely to increase to 11% by 2025, but stabilize with DAA introduction in 2015. With DAA scale-up to 80% within 1 year of diagnosis (regardless of disease stage), and 20% per year thereafter, chronic prevalence could decline by 71% (to 3.2%) compared to status quo in 2025. With additional behavioral interventions, chronic prevalence could decline further to <2.5% by 2025.
  
  
  CONCLUSIONS
  Epidemiological data and modeling suggest a continuing HCV epidemic among HIV-diagnosed MSM in the United Kingdom driven by high-risk individuals, despite high treatment rates. Substantial reductions in HCV transmission could be achieved through scale-up of DAAs and moderately effective behavioral interventions.
authors.affiliation: Division of Global Public Health, University of California San Diego.|School of Social and Community Medicine, University of Bristol.
authors.forename: Natasha K
authors.initials: NK
authors.lastname: Martin
authors.affiliation: University College London.
authors.forename: Alicia
authors.initials: A
authors.lastname: Thornton
authors.affiliation: School of Social and Community Medicine, University of Bristol.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hickman
authors.affiliation: University College London.
authors.forename: Caroline
authors.initials: C
authors.lastname: Sabin
authors.affiliation: Chelsea and Westminster Hospital.
authors.forename: Mark
authors.initials: M
authors.lastname: Nelson
authors.affiliation: Imperial College.
authors.forename: Graham S
authors.initials: GS
authors.lastname: Cooke
authors.affiliation: Division of Global Public Health, University of California San Diego.
authors.forename: Thomas C S
authors.initials: TCS
authors.lastname: Martin
authors.affiliation: Public Health England, Colindale.
authors.forename: Valerie
authors.initials: V
authors.lastname: Delpech
authors.affiliation: Medical Affairs, Gilead SciencesLtd, London.
authors.forename: Murad
authors.initials: M
authors.lastname: Ruf
authors.affiliation: Mid Essex Hospital Services NHS Trust, Chelmsford.
authors.forename: Huw
authors.initials: H
authors.lastname: Price
authors.affiliation: National AIDS Trust, London.
authors.forename: Yusef
authors.initials: Y
authors.lastname: Azad
authors.affiliation: Imperial College.|MRC University of Glasgow Centre for Virus Research, United Kingdom.
authors.forename: Emma C
authors.initials: EC
authors.lastname: Thomson
authors.affiliation: School of Social and Community Medicine, University of Bristol.
authors.forename: Peter
authors.initials: P
authors.lastname: Vickerman
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D060085:Coinfection; D015658:HIV Infections / Q000150:complications; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D018451:Homosexuality, Male; D006801:Humans; D015994:Incidence; D008297:Male; D008962:Models, Theoretical; D015995:Prevalence; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents
keywords: HIV; antiviral treatment; hepatitis C virus; men who have sex with men; prevention