Human Immunodeficiency Virus/Hepatits C Virus Coinfection in Spain: Elimination Is Feasible, but the Burden of Residual Cirrhosis Will Be Significant

Juan Berenguer, Inmaculada Jarrín, Leire Pérez-Latorre, Víctor Hontañón, María J Vivancos, Jordi Navarro, María J Téllez, Josep M Guardiola, José A Iribarren, Antonio Rivero-Juárez, Manuel Márquez, Arturo Artero, Luis Morano, Ignacio Santos, Javier Moreno, María C Fariñas, María J Galindo, María A Hernando, Marta Montero, Carmen Cifuentes, Pere Domingo, José Sanz, Lourdes Domíngez, Oscar L Ferrero, Belén De la Fuente, Carmen Rodríguez, Sergio Reus, José Hernández-Quero, Gabriel Gaspar, Laura Pérez-Martínez, Coral García, Lluis Force, Sergio Veloso, Juan E Losa, Josep Vilaró, Enrique Bernal, Sari Arponen, Amat J Ortí, Ángel Chocarro, Ramón Teira, Gerardo Alonso, Rafael Silvariño, Ana Vegas, Paloma Geijo, Josep Bisbe, Herminia Esteban, Juan González-García

We assessed the prevalence of antibodies against hepatitis C virus (HCV-Abs) and active HCV infection in patients infected with human immunodeficiency virus (HIV) in Spain in 2016 and compared the results with those of similar studies performed in 2002, 2009, and 2015. The study was performed in 43 centers during October-November 2016. The sample was estimated for an accuracy of 2% and selected by proportional allocation and simple random sampling. During 2016, criteria for therapy based on direct-acting antiviral agents (DAA) were at least significant liver fibrosis, severe extrahepatic manifestations of HCV, and high risk of HCV transmissibility. The reference population and the sample size were 38904 and 1588 patients, respectively. The prevalence of HCV-Abs in 2002, 2009, 2015, and 2016 was 60.8%, 50.2%, 37.7%, and 34.6%, respectively (P trend <.001, from 2002 to 2015). The prevalence of active HCV in 2002, 2009, 2015, and 2016 was 54.0%, 34.0%, 22.1%, and 11.7%, respectively (P trend <.001). The anti-HCV treatment uptake in 2002, 2009, 2015, and 2016 was 23.0%, 48.0%, 59.3%, and 74.7%, respectively (P trend <.001). In 2016, HCV-related cirrhosis was present in 7.6% of all HIV-infected individuals, 15.0% of patients with active HCV, and 31.5% of patients who cleared HCV after anti-HCV therapy. Our findings suggest that with universal access to DAA-based therapy and continued efforts in prevention and screening, it will be possible to eliminate active HCV among HIV-infected individuals in Spain in the short term. However, the burden of HCV-related cirrhosis will continue to be significant among HIV-infected individuals.