Cohort Profile: International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC)

The International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC) is a multinational consortium of longitudinal cohorts of people with HIV who are at risk of hepatitis C virus (HCV) infection or infected with HCV. InCHEHC has been specifically designed to assess progress towards HCV elimination as a public health threat among people with HIV. The first data merge includes 104 740 participants from 11 cohorts in Australia (n = 22 033), Canada (n = 2070), France (n = 18 387), The Netherlands (n = 24 785), Spain (n = 16 725) and Switzerland (n = 20 740), with data collected between 1987 and 2021. Participants include 86 132 males (81.4%), 19 514 females (18.4%) and 191 with unknown sex at birth (0.2%); 725 (1.0%) were known to be transgender across eight cohorts collecting data on this variable. At enrolment, the median age was 38 years (interquartile range: 30–46). Of the total 104 740 participants, 12 784 (12%) had an HCV antibody or RNA positive test at or up to 1 year prior to individual cohort enrolment; 32 360 (31%) did not have an HCV RNA or antibody test recorded at that time. Clinical data are collected on all participants and behavioural and mortality data on a subset of them. Clinical data include HIV-related markers, HCV testing and treatment, liver health-related markers and sexually transmitted and blood-borne virus co-infections. Behavioural data include sexual and injecting risk behaviours and alcohol and drug use. Mortality data are collected using the International Classification of Diseases 9th or 10th revision (ICD-9/10) or Coding Causes of Death in HIV (CoDE) classification. Data are available by request from the InCHEHC steering committee. Initial requests should be directed to Rachel Sacks-Davis (rachel.sacks-davis@burnet.edu.au). Throughout the past decade, HCV treatment has been transformed by all-oral direct-acting antiviral (DAA) therapies. Whereas cure rates using previous 24–48-week treatment regimens including interferon were typically <50%, particularly for people with HIV (PHIV),1 modern treatment with DAAs cures >95% of HCV infections in 8–12 weeks.2 Prompted by the introduction of DAA therapies for HCV, in 2016 the World Health Organization (WHO) set ambitious targets to eliminate HCV as a public health threat which included reducing HCV incidence by 80% and HCV-related mortality by 65% by 20303: a major undertaking, given the estimated 59 million people infected in 2020.4 New targets to guide validating HCV elimination were added in 2021, specifying that countries should aim for an annual HCV incidence of ≤5 per 100 000 persons in the general population and ≤2 per 100 people who inject drugs.3 The absolute HCV-related annual mortality rate target is ≤2 per 100 000 persons.3 PHIV are a key population for HCV elimination, as HCV infection is more common among PHIV and also liver disease progresses more rapidly than in individuals without HIV.5–7 HIV/HCV co-infection results in higher rates of HCV-related mortality relative to those with HCV alone.8–10 Moreover, regular clinic visits for HIV care provide opportunities for (early) HCV diagnosis and treatment in this group. Modelling suggests that if HCV treatment is scaled up, the resulting decline in HCV prevalence could drive a substantial decrease in HCV incidence.11–13 In many high-income countries, DAA treatment uptake increased shortly after its introduction,14–19 and some studies have demonstrated declines in primary HCV infection incidence rates20–25 and mortality rates when DAAs became accessible.26 However, potentially high rates of post-treatment HCV reinfection are of concern.11,27 Driven by ongoing HCV-related risk behaviour (e.g. sharing of needles, syringes and other injecting equipment and condomless anal intercourse), reinfection rates among PHIV have been estimated at 3–15 per 100 person-years (PY) for an individual’s first reinfection, and up to 23 per 100 PY for subsequent reinfections prior to the availability of DAA therapies.28–30 Reinfection rates reported by single-country studies after DAA introduction vary, depending on the populations engaged in certain behaviours associated with HCV and potentially on the methodology used.27,28,31,32 For example, among people who inject drugs, a stable reinfection incidence was observed in Canada but increases were observed in Scotland.28,32 Whereas individual cohorts can assess progress toward HCV elimination targets set by the WHO, a large multinational consortium allows for cross-country comparisons using the same methodological approaches and can provide insight into the impact of policy differences. In addition, a large multinational collaboration is required to study uncommon events within individual cohorts, for example failure to reach HCV cure and behavioural drivers of HCV reinfection following successful treatment. The International Collaboration of Hepatitis C Elimination in HIV Cohorts (InCHEHC) was established in 2017 to track progress and guide policy on elimination of HCV in PHIV. InCHEHC’s first project examined the HCV care cascade among people living with HIV in five countries (Australia, Canada, France, The Netherlands and Switzerland). Since then, a cohort from Spain has joined the collaboration. The first data merge of individual-level data was conducted in 2020–21 and a new data merge is expected in 2023. Cohorts included in InCHEHC were chosen for the availability of broad access to DAA therapies in their respective country or jurisdiction while still having differences in HCV health care-related policies (e.g. HCV RNA testing), a large coverage of PHIV or a representative sample of PHIV in their setting (Table 1), longstanding cohort data among PHIV including HCV-related clinical data collection and/or detailed HCV-related behavioural data. Data from the first data merge are described in detail below. International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC): participating cohort characteristics and data availability from the first merge, data submission 2020–21 ART, antiretroviral therapy; cART, combination ART; COREVIH, Committee to coordinate the fight against sexually transmitted infections and HIV (the COREVIHs are governmental regional centres where PHIV are seen); DAA, direct-acting antivirals; ESLD, end-stage liver disease; HAART, highly-active antiretroviral therapy; HCV, hepatitis C virus; ICD-10, International Classification of Diseases 10th Revision; MSM, men who have sex with men; NA, not applicable; PHIV, people living with HIV; PWID, people who inject drugs; STI, sexually transmitted infection. Kowalska JD et al. The Coding causes Of Death in HIV (CoDe) Project. Epidemiology 2011; 22:516–23. 66% of PHIV in care in the Australian State of Victoria in the ACCESS study who were diagnosed with HCV, and HCV RNA-positive at test in when DAA therapies became to be of PHIV living with HCV in Victoria given ACCESS of PHIV in of PHIV in care in the from 18 of 23 of the 2021. on of on 2017 governmental for the governmental regional centres where PHIV are and from on HIV. In to MSM, was included in the participants from are within the participants were included in and participants from and participants from are within the ACCESS is the was and/or recorded in a for the coverage of PHIV in care in International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC): participating cohort characteristics and data availability from the first merge, data submission 2020–21 ART, antiretroviral therapy; cART, combination ART; COREVIH, Committee to coordinate the fight against sexually transmitted infections and HIV (the COREVIHs are governmental regional centres where PHIV are seen); DAA, direct-acting antivirals; ESLD, end-stage liver disease; HAART, highly-active antiretroviral therapy; HCV, hepatitis C virus; ICD-10, International Classification of Diseases 10th Revision; MSM, men who have sex with men; NA, not applicable; PHIV, people living with HIV; PWID, people who inject drugs; STI, sexually transmitted infection. Kowalska JD et al. The Coding causes Of Death in HIV (CoDe) Project. Epidemiology 2011; 22:516–23. 66% of PHIV in care in the Australian State of Victoria in the ACCESS study who were diagnosed with HCV, and HCV RNA-positive at test in when DAA therapies became to be of PHIV living with HCV in Victoria given ACCESS of PHIV in of PHIV in care in the from 18 of 23 of the 2021. on of on 2017 governmental for the governmental regional centres where PHIV are and from on HIV. In to MSM, was included in the participants from are within the participants were included in and participants from and participants from are within the ACCESS is the was and/or recorded in a for the coverage of PHIV in care in InCHEHC is a consortium including cohorts among PHIV with or without HCV co-infection from Canada, France, The Spain and consortium includes studies from from France, from The from from Spain and from Canada (Table include or cohorts and clinical (Table of the PHIV in care not be and/or known for some cohorts, as their cohort was set up to and not to the PHIV population in care in their country or InCHEHC specifically of cohorts for large longstanding representative cohorts and cohorts with detailed behavioural data. Cohorts that individuals with HIV with or without HCV and collected longitudinal HCV-related data as HCV testing and treatment could be Participants were for in the InCHEHC if had a diagnosis of HIV and were at 18 years of total of 104 740 participants from 11 cohorts have been included in the participants and clinical characteristics at by The of cohort from 1987 to and of 11 cohorts are with ongoing of 11 cohorts have individuals the which differences in antiretroviral uptake across age from years in to years in the In all cohorts, participants were cohorts included individuals with HIV/HCV co-infection and The cohort included individuals with HCV and to include at In the cohorts, the of individuals with a positive HCV antibody and/or RNA from in to in (Table and clinical characteristics of 104 740 participants in the International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC) at cohort Australian Collaboration for in the co-infection of and Elimination within of C from people living with HIV; hepatitis C by care and treatment among HIV The cohort of HIV HCV, hepatitis C virus; Clinical of with HIV and of with hepatitis MSM, men who have sex with men; PWID, people who inject or Clinical HIV cohort key individuals were as on the recorded of HIV or HCV for cohorts with available sexual were as on recorded of HIV or HCV individuals as and were as on a positive HCV antibody or RNA test within 1 year of or first on recorded HCV For the individuals as were the and known to be HCV or at a of 1 year or after as on antiretroviral treatment or at and clinical characteristics of 104 740 participants in the International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC) at cohort Australian Collaboration for in the co-infection of and Elimination within of C from people living with HIV; hepatitis C by care and treatment among HIV The cohort of HIV HCV, hepatitis C virus; Clinical of with HIV and of with hepatitis MSM, men who have sex with men; PWID, people who inject or Clinical HIV cohort key individuals were as on the recorded of HIV or HCV for cohorts with available sexual were as on recorded of HIV or HCV individuals as and were as on a positive HCV antibody or RNA test within 1 year of or first on recorded HCV For the individuals as were the and known to be HCV or at a of 1 year or after as on antiretroviral treatment or at The from to cohorts participants cohorts between and cohort between and and after (Table The of cohorts are cohorts with ongoing (n = total of 104 740 InCHEHC participants have been for person-years (PY) from cohort their recorded study was years = from years in to years in the of person-years of and study visits in the International Collaboration on Hepatitis C Elimination in HIV Cohorts by have been in of the median and median of visits per individual included those from cohort Australian Collaboration for hepatitis C by care and treatment among HIV and Elimination within of C from people living with HIV; co-infection of with hepatitis Clinical of with HIV and HIV cohort in the Clinical the cohort of HIV The of visits per individual per and the or Australian of care for people with HIV (Table the median of study visits was 19 = from = in to = in ACCESS ACCESS visits from and including visits with the HIV-related clinical is from the other cohorts, and are more visits per in ACCESS than other approaches to to on to cohort and a across cohorts on a not for more than years their study at the of are described in detail in the as data at the annual rate of to using the approaches to the of events and time. rate of to in the International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC) using approaches to and the of and annual mortality rate using data from cohorts collecting mortality data. to up on approaches to the and Australia was from this to of collection of mortality data. at study and at known to be or at for those who Data are the year cohorts data for data the of Australian Collaboration for hepatitis C by care and treatment among HIV and Elimination within of C from people living with HIV; co-infection of with hepatitis Clinical of with HIV and HIV cohort in the Clinical the cohort of HIV on the a total of individuals were and an were known to have by the of cohort data data between and which all cohorts had and was available the and rate of was per 100 PY in = and per 100 PY in = approaches to to rates of across all for (Table 1), as using the cohort many participants were as in of subsequent visits the rates per country are in as data at The mortality rate between and was per 100 PY = between and and stable mortality rates were in Canada the co-infection in all years with the other countries, which be by the higher of or people who inject than in other cohorts available as data at and clinical differences at between individuals and those known to have on the and those on with those in those or who had were more from Switzerland were and/or RNA-positive and had a median at of participants in the International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC) on those to or known to have from the Australian cohort and and the cohort were as with from Australia and The Netherlands of MSM, men who have sex with men; PWID, people who inject or key individuals were as on recorded of HIV or HCV or sexual were as on recorded of HIV or HCV individuals as and were as as on antiretroviral treatment or at at of participants in the International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC) on those to or known to have from the Australian cohort and and the cohort were as with from Australia and The Netherlands of MSM, men who have sex with men; PWID, people who inject or key individuals were as on recorded of HIV or HCV or sexual were as on recorded of HIV or HCV individuals as and were as as on antiretroviral treatment or at data at on and clinical for all participants are described in Of are to HCV antibody and RNA testing to or past HCV and to in HCV prevalence and those after the without recorded HCV was (n = in (n = 18 in and (n = 24 in Of those HCV in and in did not have a subsequent antibody test in the following of HCV testing in the International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC) between and The in HCV among individuals in in including those The the in HCV in the subsequent among those as The the in HCV in the subsequent among those as HCV The the in HCV in the subsequent among those as to is in HCV, hepatitis C virus; past or HCV antibody or RNA positive HCV on HCV test within the study HCV test within the and previous HCV to are recorded in a subset of studies (Table include in other was on the as described in the of this from the Australian cohorts and and the cohort were as with a from Australia and The Netherlands data was to to HCV data is on the and longstanding HIV Cohorts Data by HIV-related and on a behavioural data on an collaboration of injecting this to assess data data and with the InCHEHC while subset of behavioural were across the cohorts (e.g. alcohol methodological differences between cohorts (e.g. collected specifying to cohort study and data to the on for HIV The following data were collected for all and The was collected for the following and from and from The and and ACCESS from The was to InCHEHC data availability and to data across cohorts and to data to the in with In to collected and behavioural data available from cohorts on a behavioural data from the collaboration of injecting data were collected on alcohol drug injecting and drug and of and sharing and data on the of drug or and sexual behaviour and sex with people living with HIV and/or HCV, condomless anal sex and Behavioural were for in the consortium data request if were available for at participating also a to data and added new in and to of data collected is in of data collected by the International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC) 1 of HCV, hepatitis C virus; The to which behavioural to by cohort (e.g. in the previous Behavioural were collected by a subset of cohorts, with the of detail between collected by the consortium was collected by at participating of data collected by the International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC) 1 of HCV, hepatitis C virus; The to which behavioural to by cohort (e.g. in the previous Behavioural were collected by a subset of cohorts, with the of detail between collected by the consortium was collected by at participating In cohort participants to HCV RNA and and testing at and among 18 participants testing HCV or RNA-positive In all cohorts, participants had at HCV RNA test median between the positive RNA test and was year = the first positive test the median of HCV RNA first or test and the with a recorded HCV test was = and was in as this cohort included participants with HCV between and when DAAs became available and to The of participants with at HCV per cohort and from in to in total of 12 had at and at by after their first The cohort and the Australian cohort ACCESS did not For the cohort and the Australian cohort could be cohorts collecting and of participants had at and of participants at characteristics and hepatitis data among 18 HCV and/or RNA-positive participants in the International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC) In the HCV RNA positive test at was not recorded and participants were RNA test was the HCV RNA is to be positive as this was an Moreover, participants HCV RNA-positive between their first and the Australian Collaboration for in the co-infection and Elimination within of C from people living with HIV; hepatitis C by care and treatment among HIV The cohort of HIV Clinical of with HIV and of with hepatitis MSM, men who have sex with men; PWID, people who inject or Clinical HIV cohort and of between first positive HCV test or if HCV positive test prior to and recorded key individuals were as on their recorded of HIV or HCV or sexual were as on their recorded of HIV or HCV individuals as and were as HCV RNA-positive test within on or after the first test or cohort in HIV/HCV co-infection cohorts and if first positive test was prior to cohort were on available data by the cohorts and characteristics and hepatitis data among 18 HCV and/or RNA-positive participants in the International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC) In the HCV RNA positive test at was not recorded and participants were RNA test was the HCV RNA is to be positive as this was an Moreover, participants HCV RNA-positive between their first and the Australian Collaboration for in the co-infection and Elimination within of C from people living with HIV; hepatitis C by care and treatment among HIV The cohort of HIV Clinical of with HIV and of with hepatitis MSM, men who have sex with men; PWID, people who inject or Clinical HIV cohort and of between first positive HCV test or if HCV positive test prior to and recorded key individuals were as on their recorded of HIV or HCV or sexual were as on their recorded of HIV or HCV individuals as and were as HCV RNA-positive test within on or after the first test or cohort in HIV/HCV co-infection cohorts and if first positive test was prior to cohort were on available data by the cohorts and InCHEHC’s first project was an of and in care of in the DAA The study HCV treatment uptake had increased after DAA treatment became but by of diagnosed those who had treatment, treatment and 12 or more following the of DAA treatment. Since a data merge was more detailed of in HCV incidence associated with DAA failure to HCV cure and the characteristics of PHIV who in the DAA include the data from of 11 cohorts, participants at risk of primary infection were with an primary infection incidence of per 100 PY = between and data from eight of 11 cohorts to assess in HCV reinfection, participants were for with an incidence of reinfection of per 100 PY = primary infection and reinfection broad and access to DAA treatment was associated with a decline in primary HCV of a data from of 11 cohorts from countries, people had DAA treatment data. to HCV cure was observed among of individuals who had DAA treatment and had an RNA data from of 11 cohorts from countries, a total of individuals who were HCV RNA-positive and had data the when DAA were were access to of individuals with HIV/HCV In HCV incidence broad access to DAA with a HCV reinfection incidence did not decline as as primary with many people at risk of reinfection following their treatment, HCV incidence primary and reinfection still broad access to uptake was high in InCHEHC countries but has and more is required to this to HCV to the of PHIV were were not and the of HCV antibody and RNA testing of those at risk of HCV infection between countries, and is the impact on to diagnosis of primary HCV infection and HCV DAA introduction been associated with in HCV-related mortality and has this between clinical and behavioural drive new HCV reinfections in the DAA DAA treatment associated with liver and this after the prevalence of HCV infections among individuals with HIV the of drug among men who have sex with men living with HIV by country and has InCHEHC countries were have broad availability of DAA therapies and health broad treatment, and and are to the of HCV diagnosis and DAA treatment on HCV elimination The large allows to study uncommon (e.g. reinfection and failure to HCV which a threat to HCV elimination, including by characteristics and in In cohorts collecting detailed HCV-related behavioural data are cohorts, to some have behavioural data from a subset of cohorts to be to to the impact of HCV-related behaviours on hepatitis C reinfection and assess in behavioural among other Moreover, using annual and is than per 100 PY per year between and which could be data from cohorts following individuals in high-income countries and be to or The study and coverage of the PHIV population between be when results across in some to be to For example, some cohorts include data among PHIV in care and data within a including individuals with HIV and HCV. data are collected clinical data. and HCV-related on regular and testing and this by HCV risk but not be across of cohorts detailed data and cohorts that behavioural data are HIV/HCV co-infection for to certain behaviours be for all can assess their impact on certain (e.g. risk of HCV primary that behavioural data are not available for all cohorts, of key populations is on the of HIV and HCV for cohorts with available data on sexual for cohorts without data on sexual of HCV and HIV is for key population and be individuals to or men who have sex with men than the group. Data requests are to by the study steering committee. and should be directed to the data Rachel Sacks-Davis cohorts from their or available as data at The Committee for InCHEHC of the data are available at and data project and project data and and and study was by the Australian Health and and the to this of the by the The the study participants for their to the The the of the ACCESS and ACCESS who are not of this The also all clinical participating in The of ACCESS ACCESS and participating ACCESS can be on the ACCESS ACCESS is a between the and The is by HIV and by a from the of and the for of the for Health and the of the HIV of the of of the and of Data of the of the Clinical and The to all and clinical participating in the of the Diseases of C et C et C et C et et C et et et C other C C Data The The The The The The C HIV The Health of The The steering of the study of New for Hepatitis and Health of of Health Health Health Health The all participants and from The Health Health and people from the Australian Health and and from Committee of the and C C C C representative of the and representative of including co-infection Data also the co-infection participants, the study and the for their with study and for or public from and and from and for studies from and and from and all the is by a Canada to for and/or from and and an from to to and not to and all was the for or public from and from and from and and from and all of which were to and to the from and and for in from and to to for from and and to for events from for the from the Diseases to from and all to and for participating in from and The study is by from and all to for from and from for and from to in an from and for from and from and for to this and from for to this other had to

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.