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

  • Virlogeux, Victor1, 2, 3, 4
  • Zoulim, Fabien1, 2, 3, 4
  • Pugliese, Pascal5
  • Poizot-Martin, Isabelle6
  • Valantin, Marc-Antoine7, 8
  • Cuzin, Lise9, 10, 11
  • Reynes, Jacques12
  • Billaud, Eric13
  • Huleux, Thomas14
  • Bani-Sadr, Firouze15, 16
  • Rey, David17
  • Frésard, Anne18
  • Jacomet, Christine19
  • Duvivier, Claudine20, 21
  • Cheret, Antoine21, 22
  • Hustache-Mathieu, Laurent23
  • Hoen, Bruno24
  • Cabié, André25, 26
  • Cotte, Laurent2, 27, 4
  • 1 Department of Hepatology, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France , Lyon (France)
  • 2 Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon, Lyon, F-69008, France , Lyon (France)
  • 3 Centre for Clinical Research, Department of Hepatology, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France , Lyon (France)
  • 4 Lyon University, Lyon, France , Lyon (France)
  • 5 Department of Infectious Diseases, Centre Hospitalier Universitaire de Nice, Hôpital l’Archet, Nice, France , Nice (France)
  • 6 Aix-Marseille University, APHM Hôpital Sainte-Marguerite, Service d’Immuno-hématologie clinique, INSERM U912 (SESSTIM), Marseille, 13009, France , Marseille (France)
  • 7 Department of Infectious Diseases, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France , Paris (France)
  • 8 Sorbonne Université, UPMC Université Paris 06, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France , Paris (France)
  • 9 CHU Toulouse, COREVIH Toulouse, Toulouse, France , Toulouse (France)
  • 10 Université de Toulouse III, Toulouse, France , Toulouse (France)
  • 11 INSERM, UMR 1027, Toulouse, France , Toulouse (France)
  • 12 Department of Infectious Diseases, UMI 233 INSERM U1175, CHU de Montpellier, Montpellier, France , Montpellier (France)
  • 13 Department of Infectious Diseases, Hotel-Dieu Hospital, Nantes, France , Nantes (France)
  • 14 Department of Infectious Diseases and Travel Diseases, Centre Hospitalier Gustave-Dron, Tourcoing, France , Tourcoing (France)
  • 15 Department of Internal Medicine, Infectious Diseases and Clinical Immunology, Hôpital Robert Debré, CHU Reims, Reims, France , Reims (France)
  • 16 Université de Reims Champagne-Ardenne, Faculté de Médecine, EA-4684/SFR CAP-SANTE, Reims, France , Reims (France)
  • 17 HIV Infection Care Centre, Hôpitaux Universitaires, Strasbourg, France , Strasbourg (France)
  • 18 Department of Infectious Diseases, CHU Saint-Etienne, Saint-Priest-en-Jarez, France , Saint-Priest-en-Jarez (France)
  • 19 Department of Infectious Diseases, CHU Clermont-Ferrand, Clermont-Ferrand, France , Clermont-Ferrand (France)
  • 20 Department of Infectious Diseases, Centre d’Infectiologie Necker-Pasteur, IHU Imagine, Assistance Publique - Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France , Paris (France)
  • 21 Université Paris Descartes, Sorbonne Paris Cité, EA7327, Paris, France , Paris (France)
  • 22 Department of Internal Medicine, CHU Bicètre, Paris, France , Paris (France)
  • 23 Department of Infectious Diseases, CHRU de Besançon, Besançon, France , Besançon (France)
  • 24 Faculté de Médecine Hyacinthe Bastaraud, Université des Antilles, and Service de Maladies Infectieuses et Tropicales, Dermatologie et Médecine Interne, and INSERM CIC 1424, Centre Hospitalier Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, France , Pointe-à-Pitre (France)
  • 25 Department of Infectious Diseases, CHU de Martinique, Fort-de-France, France , Fort-de-France (France)
  • 26 Université des Antilles EA4537 and INSERM CIC1424, Fort-de-France, France , Fort-de-France (France)
  • 27 Department of Infectious Diseases and Tropical Medicine, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la Croix-Rousse, Lyon, CEDEX 04, 69317, France , Lyon (France)
Published Article
BMC Medicine
BioMed Central
Publication Date
Dec 18, 2017
DOI: 10.1186/s12916-017-0979-1
Springer Nature


BackgroundHCV 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.MethodsThe 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.ResultsOn 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.ConclusionsOur 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.

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