Modeling HIV-HCV coinfection epidemiology in the direct-acting antiviral era: the road to elimination

Victor Virlogeux (1, 2, 3) , Fabien Zoulim (2, 1, 3) , Pascal Pugliese (4) , Isabelle Poizot-Martin (5, 6) , Marc-Antoine Valantin (7, 8) , Lise Cuzin (9, 10) , Jacques Reynes (11, 12) , Eric Billaud (13) , Thomas Huleux (14) , Firouzé Bani-Sadr (15, 16) , David Rey (17) , Anne Frésard (18) , Christine Jacomet (19) , Claudine Duvivier (20, 21) , Antoine Cheret (21, 22) , Laurent Hustache-Mathieu (23) , Bruno Hoen (24, 25) , André Cabié (26, 27, 25) , Laurent Cotte (28, 3)

1 Service d'Hépatologie [Hôpital de la Croix-Rousse - HCL]
2 HCL - Hospices Civils de Lyon
3 UNICANCER/CRCL - Centre de Recherche en Cancérologie de Lyon
4 Service de Maladies Infectieuses [Nice]
5 Service d'immuno-hématologie clinique (CISIH)
6 SESSTIM - U912 INSERM - Aix Marseille Univ - IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale
7 CHU Pitié-Salpêtrière [AP-HP]
8 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
9 LEASP - Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps
10 COREVIH [Toulouse] - Coordination régionale de la lutte contre le virus de l’immunodéficience humaine
11 TransVIHMI - Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes
12 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
13 Service des maladies infectieuses [Nantes]
14 Service Universitaire des Maladies Infectieuses et du Voyageur [Tourcoing]
15 Unité des Maladies Infectieuses et Tropicales
16 CardioVir - Laboratoire de Virologie Médicale et Moléculaire - EA 4684
17 HUS - Les Hôpitaux Universitaires de Strasbourg
18 CHU ST-E - Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne]
19 CHU Clermont-Ferrand
20 Centre d'infectiologie Necker-Pasteur [CHU Necker]
21 EA 7327 - Infection à VIH, réservoirs, diversité génétique et résistance aux antirétroviraux (ARV)
22 Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
23 service de maladies infectieuses CHU J Minjoz Besancon
24 Service des Maladies Infectieuses et Tropicales [Point-à-Pitre]
25 CIC - Antilles Guyane - Centre d'Investigation Clinique Antilles-Guyane
26 Service de Maladies Infectieuses et Tropicales [Fort-de-France, Martinique]
27 MAITC EA 4537 - Maladies infectieuses et tropicales dans la Caraïbe
28 Service de Maladies Infectieuses et Tropicales [Hôpital de la Croix-Rousse - HCL]

Background: HCV treatment uptake has drastically increased in HIV-HCV coinfected patients in France since direct-acting antiviral (DAA) treatment approval, resulting in HCV cure in 63% of all HIV-HCV patients by the end of 2015. We investigated the impact of scaling-up DAA on HCV prevalence in the whole HIV population and in various risk groups over the next 10 years in France using a transmission dynamic compartmental model. Methods: The model was based on epidemiological data from the French Dat’AIDS cohort. Eight risk groups were considered, including high-risk (HR) and low-risk (LR) men who have sex with men (MSM) and male/female heterosexuals, intra-venous drug users, or patients from other risk groups. The model was calibrated on prevalence and incidence data observed in the cohort between 2012 and 2015. Results: On January 1, 2016, 156,811 patients were registered as infected with HIV in France (24,900 undiagnosed patients) of whom 7938 (5.1%) had detectable HCV-RNA (722 undiagnosed patients). Assuming a treatment coverage (TC) rate of 30%/year (i.e., the observed rate in 2015), model projections showed that HCV prevalence among HIV patients is expected to drop to 0.81% in 2026. Sub-analyses showed a similar decrease of HIV-HCV prevalence in most risk groups, including LR MSM. Due to higher infection and reinfection rates, predicted prevalence in HR MSM remained stable from 6.96% in 2016 to 6.34% in 2026. Increasing annual TC rate in HR MSM to 50/70% would decrease HCV prevalence in this group to 2.35/1.25% in 2026. With a 30% TC rate, undiagnosed patients would account for 34% of HCV infections in 2026. Conclusions: Our model suggests that DAA could nearly eliminate coinfection in France within 10 years for most risk groups, including LR MSM. Elimination in HR MSM will require increased TC.

Mots clés: Compartmental model; Coinfection; Treatment uptake; Mathematical modeling; HIV; HCV elimination; Direct-acting antiviral agent; HCV

Domaines: Santé publique et épidémiologie

Victor Virlogeux, Fabien Zoulim, Pascal Pugliese, Isabelle Poizot-Martin, Marc-Antoine Valantin, et al.. Modeling HIV-HCV coinfection epidemiology in the direct-acting antiviral era: the road to elimination. BMC Medicine, 2017, 15 (1), pp.217. ⟨10.1186/s12916-017-0979-1⟩. ⟨inserm-01685739⟩