Marked Reduction in HIV/HCV Coinfections in Iceland Following the TraP HepC Nationwide Hepatitis C Elimination Program.

Background: The nationwide Treatment as Prevention program for Hepatitis C (TraP HepC) was initiated in Iceland in 2016, where direct-acting antivirals (DAAs) replaced interferon-based treatments for hepatitis C virus (HCV). The study aimed to assess the impact of TraP HepC on the epidemiology of HIV/HCV coinfection, the cascade of care, and HCV reinfection rates among coinfected individuals. Methods: A nationwide retrospective study was conducted on all people with HIV in Iceland who tested HCV antibody positive during 2000-2020. Medical records, laboratory results, and treatment outcomes were reviewed and analyzed by treatment era: interferon (2000-2015) and DAA (2016-2020). Results: Out of 648 people with HIV, 78 were HCV antibody positive during 2000-2020, of whom 61 had confirmed HCV viremia. The total number of HIV/HCV-coinfected individuals increased steadily, peaking at 41 in 2016, but decreased by >85% to 6 by 2020 following the nationwide TraP HepC program. In total, 84 active HCV infections including reinfections were diagnosed, which prompted 81 treatment initiations and yielded 66 cures. During the interferon era, 45% (13/29) achieved cure, compared with 88% (53/60; P < .001) in the DAA era. The HCV reinfection rate in this group was 9.35/100 person-years, all presumed to be acquired by injection drug use. Conclusions: Before the nationwide elimination campaign, the incidence of HIV/HCV coinfections was steadily increasing, but it has subsequently decreased by >85%, primarily due to the widespread use of DAAs. However, high reinfection rates in this population suggest that ongoing prevention, early diagnosis, and easy access to DAAs are necessary to maintain success.