One-third of individuals with HIV and hepatitis C are not getting treatment for their hepatitis C infection despite being eligible for it. Commencing treatment was found to be more frequent in certain countries (Australia, France, and the Netherlands) and in men who have sex with men.

According to the most recent global estimates, 38 million people are living with HIV and approximately 2 to 3 million people have HIV and the hepatitis C virus (HCV). Since access to highly effective direct-acting antiviral therapy for the treatment of HCV has become unrestricted in many high-income countries, HCV treatment coverage has increased rapidly, and HCV incidence and the percentage of HCV viremic individuals among people living with HIV have declined sharply in some countries.

Nevertheless, treatment use has declined after initial rapid uptake allowed a large proportion of the population with HIV and HCV to be treated. The fact that some people remain untreated, even in a context of unrestricted access, suggests that barriers to direct-acting antiviral treatment remain. Because individuals who remain untreated may contribute to the ongoing transmission of HCV and are at risk of HCV-related mortality, accelerating their treatment uptake is essential to achieve HIV-HCV microelimination.

No reason why individuals should be left untreated

This study examined how quickly people with hepatitis C virus (HCV) who also have HIV receive HCV drugs in six different countries (Australia, Canada, France, the Netherlands, Spain and Switzerland). According to the routine care provided by these countries, there is no reason why those included in the study not have commenced treatment. Unfortunately, a third of them remained untreated.

Further examination of the data reveals that not all countries were able to treat persons with HCV as quickly as other countries. Australia, France and the Netherlands were faster in getting individuals started on HCV medication compared to the other countries. Men who have sex with men, persons who follow care more closely, and persons more recently diagnosed with HCV also received treatment much earlier. This leaves others behind who could potentially benefit from this life-saving treatment.

The results of this study demonstrate the difficulty of ensuring access to HCV treatment for all who need it, despite unrestricted access. Innovative ways to engage people in health care may be needed to encourage broader treatment coverage.

For more information, contact Marc van der Valk or read the scientific publication.

Researchers involved at Amsterdam UMC

C.J. Isfordink, PhD candidate Infectious Diseases at Amsterdam UMC

A. Boyd, Biostatistician Infectious Diseases at Amsterdam UMC / Stichting hiv monitoring (SHM)

D.K. Van Santen, Postdoctoral Research Fellow CAUSALab, Boston, Massachusetts, United States

C. Smit, Research Associate Infectious Diseases at Amsterdam UMC / Stichting hiv monitoring (SHM)

C.J. Schinkel, Head of Clinical Microbiology Laboratories at the Department of Medical Microbiology, Amsterdam UMC

M. van der Valk, professor of Medicine at Amsterdam UMC/ Stichting hiv monitoring (SHM)

Isfordink, C. J., Boyd, A., Sacks-Davis, R., van Santen, D. K., Smit, C., Martinello, M., Stoove, M., Berenguer, J., Wittkop, L., Klein, M. B., Rauch, A., Salmon, D., Lacombe, K., Stewart, A., Schinkel, J., Doyle, J. S., Hellard, M., van der Valk, M., Matthews, G., V. (2023). Reasons for not commencing direct-acting antiviral treatment despite unrestricted access for individuals with HIV and hepatitis C virus: a multinational, prospective cohort study. Lancet Public Health. doi: 10.1016/S2468-2667(23)00056-7

Learn more about our Amsterdam institute for Infection and Immunity HIV research:

The Netherlands on its way to zero new HIV infections (November 2022)

Risk factors for cardiovascular disease in HIV-1 infected patients in sub-saharan Africa (October 2022)

Vaginal bacteria increases risk of HIV infection (September 2022)