The United Kingdom is close to eliminating hepatitis C as an
infection among people with HIV, according to an audit of HIV services carried
out in 2021, published in the journal HIV Medicine.
The British HIV Association (BHIVA) set the target of
micro-elimination of hepatitis C in people living with HIV in the UK by 2021. To demonstrate progress towards this target and assess the
impact of the COVID-19 pandemic on progress, BHIVA carried out an audit of HIV
clinics in the UK in 2021.
The audit questioned 95 clinics about the
policies regarding the management of patients with HIV and hepatitis C, the
current hepatitis C RNA status of all patients with a history of HIV/hepatitis
C co-infection and the impact of COVID-19 on hepatitis C testing and treatment.
Eighty-one participating clinics provided full caseload
data, reporting on 3951 people with hepatitis C among 68,368 people with HIV
receiving care at their clinics (5.9%).
Of those with a history of hepatitis C, 193 had detectable
HCV RNA, of which 122 were already undergoing or about to start treatment. As
the participating clinics represented approximately two-thirds of people with
HIV in care in the UK, the audit investigators estimate that the
number of people with HIV who had untreated hepatitis co-infection was in the
low hundreds in 2021.
Asked what measures they had taken to achieve high treatment
rates, clinics most often reported close working relationships with hepatology
clinics and clear referral pathways (41%) and close liaison with community
outreach, drugs and alcohol services (16%). Most clinics (78%) reported little
impact of COVID-19; the most common effects were delays or changes in
monitoring, delays in treatment initiation and changes in treatment dispensing.
One third of clinics were providing peer support to people
with HIV and hepatitis C and 42% provided home or community visits to improve
engagement in care. Eighty percent provided a partner notification programme
for HIV and hepatitis C.
Seventy-four clinics contributed to a case-note review of
people with undetectable HCV RNA (the remainder had no patients with detectable
HCV RNA at the time of the audit).
Of the 159 people who remained untreated at the time of the
case-note review, one-third were due to start treatment shortly and eleven were
recently diagnosed and under observation to check if the hepatitis C virus was
cleared spontaneously.
More than half of those who remained untreated were not
engaged in care (54%) and a further 26 people could not be contacted due to the
lack of a phone number.
Only 17% of those untreated had turned down the offer of
treatment, while just over 10% had not been treated because they were not
expected to adhere to treatment or because they were considered to be at
significant risk of reinfection after treatment. It was unclear from the
information available to the audit whether the reason for not treating due to
reinfection risk was a consequence of restrictions on prescribing or
represented a judgement by the treating physician. Fourteen clinics told the
audit they were uncertain if funding would be available for repeat treatment.
The audit group conclude that achieving micro-elimination of
hepatitis C in people with HIV will require efforts to locate people disengaged
from care and understand the reasons why they are not in care, as well as efforts
to improve knowledge of hepatitis C treatment in those who have chosen not to
undergo treatment.
Continued screening for hepatitis C infection and re-infection
will also be needed to ensure that people with HIV receive timely treatment for
hepatitis C.