Viral hepatitis is responsible for more deaths globally than HIV and malaria, with hepatitis C virus (HCV) accounting for a third of viral hepatitis-related deaths. HCV infection is more common in people living with HIV, and mortality rates are 12 times greater, making those with HIV a key group.
In 2013 HCV treatment was transformed through the availability of all-oral direct-acting antiviral (DAA) therapy. In as little as 8–12 weeks of treatment, >95 per cent of patients are cured of HCV, including HIV/HCV-coinfected individuals whose previous cure rates were <50 per cent.
In 2016, the World Health Organization (WHO) set targets for the elimination of hepatitis C as a public health threat by 2030, including an 80 per cent reduction in HCV incidence and 65 per cent reduction in HCV-related mortality.
HCV elimination is a tantalising goal but it may be difficult to achieve if there is suboptimal access to treatment, high levels of reinfection, and/or treatment failure in those at high risk of onward transmission. Despite scepticism that the elimination targets will be achieved globally, there is optimism that local elimination of HCV (micro-elimination) can be achieved in some populations, including among HIV/HCV-coinfected populations.
A multinational cohort of people living with HIV who are at risk of HCV infection or who have been infected with HCV will provide an opportunity to learn early lessons about HCV elimination success and failure.
The International Collaboration on Hepatitis C Elimination in HIV-Coinfection (InCHEHC) will pool date from 15 observational cohorts from eight countries, including data from approximately 75,000 participants, and will be the largest cohort of people living with HIV with well characterised data on HCV coinfection internationally. Importantly, the large size of the cohort will enable us to measure and identify correlates of rare outcomes that cannot be analysed within individual cohorts or countries, such as HCV reinfection after successful treatment, treatment failure and liver-related mortality.
This large international cohort will allow interim assessment of the WHO elimination targets in 2020-2022, facilitating refinement of policy and practice within the target period (by 2030).
2019 – 2022