Hepatitis C RNA Prevalence before and during Broad Access to Direct-Acting Antivirals in People with HIV across Six Countries
Abstract
BACKGROUND & AIMS: Hepatitis C virus (HCV) RNA prevalence is a key measure in monitoring progress towards elimination. We estimate the effect of limited and broad availability of direct-acting antiviral (DAA) therapies on HCV RNA prevalence among people with HIV, accounting for variations in testing frequency. METHODS: Data from six countries of cohorts participating in the International Collaboration on Hepatitis Elimination in HIV Cohorts (InCHEHC) were included. Follow-up spanned from five years before each country's broad DAA-access date to database closure (5-8 years post-access). To address variation in HCV testing frequency, we applied a population-averaged approach to estimate HCV RNA prevalence and to quantify changes across pre-DAA access (reference), limited-access, and broad-access periods. RESULTS: Among 107,532 individuals (863,734 person-years), baseline adjusted HCV RNA prevalence ranged from 3.6% (95%CI:3.3-3.9) in the Netherlands to 11.6% (95%CI:10.8-12.4) in Italy. Relative to pre-DAAs, annual declines in RNA prevalence during limited access ranged from 6% in Italy and Spain (95%CIs:4-7% and 3-8%, respectively) to 21% in the Netherlands (95%CI:17-24%). During broad access, annual declines ranged from 7% in Spain (95%CI:5-9%) to 27% in Switzerland (95%CI:25-30%). From COVID-19 onwards, prevalence declined at a slower rate in France, Italy, the Netherlands, Spain and Switzerland, and increased in Australia. After five years of broad DAA access, prevalence ranged from 0.4% (0.3-0.5) in the Netherlands to 3.3% (2.8-3.8) in Italy. CONCLUSION: HCV RNA prevalence was stable or slightly decreasing before DAA availability in six InCHEHC countries. After DAAs became available, substantial reductions in HCV RNA prevalence were seen among people with HIV, primarily reflecting cured chronic infections and possibly reduced transmission risk. IMPACT AND IMPLICATIONS: Our study shows that the introduction and scale-up of direct-acting antiviral therapies led to substantial and sustained reductions in HCV RNA prevalence among people with HIV across six countries, demonstrating the population-level impact of widespread treatment access on chronic infection and potential transmission. These findings highlight the effectiveness of national DAA strategies, while also underscoring the risk of stalled progress during external disruptions such as the COVID-19 pandemic. We also show that routinely collected clinical data, when appropriately adjusted for testing patterns, can provide reliable estimates of HCV prevalence to monitor progress toward elimination targets. Sustaining high levels of testing and treatment access, particularly in lower-prevalence, post-scale-up settings, will be critical to maintaining momentum toward HCV elimination.
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BibTeX
@article{stewart2026hepatitis,
title = {{Hepatitis C RNA Prevalence before and during Broad Access to Direct-Acting Antivirals in People with HIV across Six Countries}},
author = {Ashleigh C. Stewart and Constantin T. Yiannoutsos and Damian Pavlyshyn and Linda Wittkop and Fabrice Bonnet and Inmaculada Jarrín and Juan Berenguer and Lukas Baumann and Katharina Kusejko and Marc van Der Valk and Colette Smit and Mark A. Stoové and Jason Asselin and Joseph S. Doyle and Marina Klein and Karine Lancombe and Dominique Salmon and Gail Matthews and Maria Prins and Giorgos Bakoyannis and Beverly Musick and Margaret Hellard and Rachel Sacks-Davis and Inchehc Study Group},
journal = {JHEP Reports Innovation in Hepatology},
year = {2026},
month = oct,
doi = {10.1016/j.jhepr.2026.102054},
url = {https://hal.science/hal-05784436v1},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Hepatitis C RNA Prevalence before and during Broad Access to Direct-Acting Antivirals in People with HIV across Six Countries
AU - Ashleigh C. Stewart
AU - Constantin T. Yiannoutsos
AU - Damian Pavlyshyn
AU - Linda Wittkop
AU - Fabrice Bonnet
AU - Inmaculada Jarrín
AU - Juan Berenguer
AU - Lukas Baumann
AU - Katharina Kusejko
AU - Marc van Der Valk
AU - Colette Smit
AU - Mark A. Stoové
AU - Jason Asselin
AU - Joseph S. Doyle
AU - Marina Klein
AU - Karine Lancombe
AU - Dominique Salmon
AU - Gail Matthews
AU - Maria Prins
AU - Giorgos Bakoyannis
AU - Beverly Musick
AU - Margaret Hellard
AU - Rachel Sacks-Davis
AU - Inchehc Study Group
PY - 2026
DA - 2026/10/07
JO - JHEP Reports Innovation in Hepatology
DO - 10.1016/j.jhepr.2026.102054
UR - https://hal.science/hal-05784436v1
AB - BACKGROUND & AIMS: Hepatitis C virus (HCV) RNA prevalence is a key measure in monitoring progress towards elimination. We estimate the effect of limited and broad availability of direct-acting antiviral (DAA) therapies on HCV RNA prevalence among people with HIV, accounting for variations in testing frequency. METHODS: Data from six countries of cohorts participating in the International Collaboration on Hepatitis Elimination in HIV Cohorts (InCHEHC) were included. Follow-up spanned from five years before each country's broad DAA-access date to database closure (5-8 years post-access). To address variation in HCV testing frequency, we applied a population-averaged approach to estimate HCV RNA prevalence and to quantify changes across pre-DAA access (reference), limited-access, and broad-access periods. RESULTS: Among 107,532 individuals (863,734 person-years), baseline adjusted HCV RNA prevalence ranged from 3.6% (95%CI:3.3-3.9) in the Netherlands to 11.6% (95%CI:10.8-12.4) in Italy. Relative to pre-DAAs, annual declines in RNA prevalence during limited access ranged from 6% in Italy and Spain (95%CIs:4-7% and 3-8%, respectively) to 21% in the Netherlands (95%CI:17-24%). During broad access, annual declines ranged from 7% in Spain (95%CI:5-9%) to 27% in Switzerland (95%CI:25-30%). From COVID-19 onwards, prevalence declined at a slower rate in France, Italy, the Netherlands, Spain and Switzerland, and increased in Australia. After five years of broad DAA access, prevalence ranged from 0.4% (0.3-0.5) in the Netherlands to 3.3% (2.8-3.8) in Italy. CONCLUSION: HCV RNA prevalence was stable or slightly decreasing before DAA availability in six InCHEHC countries. After DAAs became available, substantial reductions in HCV RNA prevalence were seen among people with HIV, primarily reflecting cured chronic infections and possibly reduced transmission risk. IMPACT AND IMPLICATIONS: Our study shows that the introduction and scale-up of direct-acting antiviral therapies led to substantial and sustained reductions in HCV RNA prevalence among people with HIV across six countries, demonstrating the population-level impact of widespread treatment access on chronic infection and potential transmission. These findings highlight the effectiveness of national DAA strategies, while also underscoring the risk of stalled progress during external disruptions such as the COVID-19 pandemic. We also show that routinely collected clinical data, when appropriately adjusted for testing patterns, can provide reliable estimates of HCV prevalence to monitor progress toward elimination targets. Sustaining high levels of testing and treatment access, particularly in lower-prevalence, post-scale-up settings, will be critical to maintaining momentum toward HCV elimination.
SN - 2589-5559
ER -