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Hepatitis C virus infection is uncommon at baseline and during follow-up among individuals using PrEP in the Dutch national PrEP programme between 2019 and 2022
  1. Kris Hage1,2,3,
  2. Anders Boyd1,2,3,4,
  3. Eline L M Op de Coul5,
  4. Danja Sarink5,
  5. Elske Hoornenborg1,3,6,7,
  6. Maria Prins1,2,3,7
  1. 1Public Health Service of Amsterdam, Department of Infectious Diseases, Research and Prevention, Amsterdam, The Netherlands
  2. 2Amsterdam UMC, University of Amsterdam, Infectious Diseases, Amsterdam, The Netherlands
  3. 3Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, The Netherlands
  4. 4Stichting hiv monitoring, Amsterdam, The Netherlands
  5. 5Centre for Infectious Disease Control, Epidemiology and Surveillance, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
  6. 6Amsterdam UMC, University of Amsterdam, Internal Medicine, Amsterdam, The Netherlands
  7. 7Amsterdam Public Health Research Institute (APH), Amsterdam, The Netherlands
  1. Correspondence to Kris Hage, Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam, Amsterdam 1018 DW, The Netherlands; khage{at}ggd.amsterdam.nl

Abstract

Objectives Studies showed that men who have sex with men (MSM), including those using pre-exposure prophylaxis (PrEP), are at increased risk of hepatitis C virus (HCV) infection. We evaluated HCV prevalence and incidence, along with their associated determinants, in a cohort of PrEP-using individuals in the Netherlands.

Methods In 2019, the Netherlands launched a 5-year national programme that offers subsidised PrEP to eligible individuals. We used prospectively collected data from individuals registered in this programme between 2019 and 2022. Individuals underwent annual testing for HCV antibodies and additional HCV-RNA testing when antibodies were present. We calculated the prevalence of past/current HCV infection at first visit and overall incidence rate (IR) during follow-up. Univariable logistic and Poisson regression models were used to identify determinants associated with past/current prevalent or incident HCV infection, respectively. Behavioural factors referred to those occurring in the previous 6 months.

Results A total of 10 563 (n=10 319, 97.7% MSM) were included. At first visit, 66 of 10 563 (0.6%) had a past/current HCV infection, which was associated with older age [odds ratio (OR) per 10 years=1.57, 95% confidence interval (CI)=1.31 to 1.88], the use of PrEP before first visit (OR=3.03, 95% CI=1.79 to 5.13), receptive condomless anal sex (CAS) (OR=2.73, 95% CI=1.25 to 5.98), chemsex (OR=2.44, 95% CI=1.49 to 3.99) and injecting drug use (IDU) (OR=6.61, 95% CI=2.35 to 18.61). Among 9851 individuals contributing to 17 150 person-years (PYs) of follow-up, 64 incident HCV infections (IR=0.37 per 100 PYs, 95% CI=0.29 to 0.48) were identified. Factors associated with incident HCV infection were receptive CAS [incidence rate ratio (IRR)=2.59, 95% CI=1.12 to 6.02], chemsex (IRR=1.78, 95% CI=1.06 to 2.98), sexually transmitted infection diagnosis (IRR=2.30, 95% CI=1.23 to 4.31) and IDU (IRR=6.15, 95% CI=2.20 to 17.18).

Conclusions Past/current prevalence and incidence of HCV were low among individuals in the Dutch PrEP programme. Infections were associated with behaviour known to be associated with HCV. Instead of annual HCV testing, as stated in most PrEP care guidelines, testing frequency for HCV could be based on behaviours associated with HCV acquisition.

  • HEPATITIS C
  • Pre-Exposure Prophylaxis
  • Transgender Persons
  • Men who have Sex with Men

Data availability statement

Data are available upon reasonable request. This study used data from the Dutch national registration of SHC consultations (SOAP). Pseudomised individual participant data can be requested for scientific use with a methodologically sound proposal submitted to the SOAP registration committee for approval. Proposal forms and additional information can be requested via soap@rivm.nl. Data requestors will need to sign a data access agreement.

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Data availability statement

Data are available upon reasonable request. This study used data from the Dutch national registration of SHC consultations (SOAP). Pseudomised individual participant data can be requested for scientific use with a methodologically sound proposal submitted to the SOAP registration committee for approval. Proposal forms and additional information can be requested via soap@rivm.nl. Data requestors will need to sign a data access agreement.

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Footnotes

  • Handling editor Michael Traeger

  • Contributors KH contributed to the conception and design of the work, performed data management and data analysis and drafted the manuscript. AB contributed to the conception and design of the work, analysis of data and interpretation of the data. ELMOdC and EH contributed to the conception and design of the work. DS contributed to the conception and design of the work and data management. MP contributed to the conception and design of the work and interpretation of data. All authors critically revised the manuscript, and all approved the final version. MP was the guarantor, and therefore accept full responsibility for thw ork and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding KH was supported by the Netherlands Organization for Health Research and Development (ZonMw) (grant number 522004006).

  • Competing interests AB has received speaker fees from Gilead Sciences, independent from the current work. EH received unrestricted research grants from Gilead Sciences paid to her institute. MP’s institution has received speaker fees and independent scientific support from Gilead Sciences, Roche, MSD and AbbVie, unrelated to the current work. All other authors report no potential conflicts.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.