Can Hepatitis C Virus (HCV) Direct-Acting Antiviral Treatment as Prevention Reverse the HCV Epidemic among Men Who Have Sex with Men in the United Kingdom? Epidemiological and Modeling Insights

Natasha K. Martin*, Alicia Thornton, Matthew Hickman, Caroline Sabin, Mark Nelson, Graham S. Cooke, Thomas C.S. Martin, Valerie Delpech, Murad Ruf, Huw Price, Yusef Azad, Emma C. Thomson, Peter Vickerman

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

104 Citations (Scopus)


We report on the hepatitis C virus (HCV) epidemic among human immunodeficiency virus (HIV)-positive men who have sex with men (MSM) in the United Kingdom and model its trajectory with or without scaled-up HCV direct-acting antivirals (DAAs). Methods. A dynamic HCV transmission model among HIV-diagnosed MSM in the United Kingdom was calibrated to HCV prevalence (antibody [Ab] or RNA positive), incidence, and treatment from 2004 to 2011 among HIV-diagnosed MSM in the UK Collaborative HIV Cohort (UK CHIC). The epidemic was projected with current or scaled-up HCV treatment, with or without a 20% behavioral risk reduction. Results. HCV prevalence among HIV-positive MSM in UK CHIC increased from 7.3% in 2004 to 9.9% in 2011, whereas primary incidence was flat (1.02-1.38 per 100 person-years). Over the next decade, modeling suggests 94% of infections are attributable to high-risk individuals, comprising 7% of the population. Without treatment, HCV chronic prevalence could have been 38% higher in 2015 (11.9% vs 8.6%). With current treatment and sustained virological response rates (status quo), chronic prevalence is likely to increase to 11% by 2025, but stabilize with DAA introduction in 2015. With DAA scale-up to 80% within 1 year of diagnosis (regardless of disease stage), and 20% per year thereafter, chronic prevalence could decline by 71% (to 3.2%) compared to status quo in 2025. With additional behavioral interventions, chronic prevalence could decline further to <2.5% by 2025. Conclusions. Epidemiological data and modeling suggest a continuing HCV epidemic among HIV-diagnosed MSM in the United Kingdom driven by high-risk individuals, despite high treatment rates. Substantial reductions in HCV transmission could be achieved through scale-up of DAAs and moderately effective behavioral interventions.

Original languageEnglish
Pages (from-to)1072-1080
Number of pages9
JournalClinical Infectious Diseases
Issue number9
Publication statusPublished - 1 May 2016

Bibliographical note

Funding Information:
This work was supported by a research grant from Gilead Sciences. This work was additionally supported by the National Institute on Drug Abuse (grant number R01DA037773-01A1) to N. K. M., P. V., and M. H.; University of California, San Diego Center for AIDS Research (CFAR), a National Institutes of Health (NIH)-funded program (grant number P30 AI036214) to N. K. M.; National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions at University of Bristol (to P. V. and M. H.); NIHR HPRU in sexually transmitted infections and blood-bourne viruses at University College London (to A. T. and C. S.); and the Wellcome Trust (WT 102789 to E. C. T.). The UK CHIC study has received funding from the Medical Research Council.

Publisher Copyright:
© 2016 The Author.


  • HIV
  • Hepatitis C virus
  • antiviral treatment
  • men who have sex with men
  • prevention


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