Integrating HCV and HIV services improves HCV testing and awareness among people who inject drugs in India: findings from a cluster randomized trial

Background: Hepatitis C virus (HCV) prevalence was 4.8% among HIVnegative men who have sex with men (MSM) starting preexposure prophylaxis (PrEP) in the Netherlands. We studied the HCV incidence rate (IR), characteristics of newly infected individuals, HCV genotype distribution and phylogenetic clustering among MSM and transgender persons (TGP) who use PrEP in the Netherlands. Methods: HIVnegative MSM (n = 374) and TGP (n = 2) participating in the Amsterdam PrEP project at the Public Health Service of Amsterdam were tested biannually for HCV antibodies, and subsequently for HCV RNA if antibodies were present. We analyzed data from study start (August 2015) through December 2017. We calculated the HCV IR, overall and separately for primary infection and reinfection, and described baseline characteristics of participants with incident HCV infection. HCV genotyping was performed by sequencing part of the HCV NS5B gene (420 bp). Phylogenetic trees were constructed to compare HCV strains from HIVnegative participants, HIVpositive MSM with acute or chronic HCV in Amsterdam and Dutch risk groups other than MSM. Results: The median followup was 1.76 person years (py) (IQR 1.57–1.98). We diagnosed 12 incident HCV infections, all in MSM: 6 primary infections and 6 reinfections. The overall HCV IR was 1.9/100 py (95% CI 1.1–3.4). The IR of primary infection was 1.0/100 py (95% CI 0.5–2.2) and of reinfection 25.5/100 py (95% CI 11.5–56.8). Incident HCV infections were of genotype 1a (n = 9), 4d (n = 1), 2b (n = 1) and 3a (n = 1). Phylogenetic analysis revealed that 8/9 HCV1a infections were part of 4 large MSMspecific HCV1a clusters containing MSM with and without HIV. Median age of those with incident infection was 35 years (IQR 26–41), most were white (83%), chose for daily PrEP (92%) and reported chemsex (75%) before initiating PrEP. Conclusion: In the Netherlands, incidence of initial and reHCV infection among HIVnegative MSM on PrEP was high and comparable to that observed in HIVpositive MSM. The high degree of phylogenetic clustering between HCV strains acquired by MSM with and without HIV suggests a shared transmission network. Regular HCV testing to provide prompt treatment as well interventions to lower HCVrelated behavior should be offered to MSM on PrEP. Disclosure­of­ Interest: E. Hoornenborg: None Declared, L. Coyer: None Declared, R. Achterbergh: None Declared, M. Schim van der Loeff: None Declared, S. Bruisten: None Declared, H. de Vries: None Declared, T. van de Laar: None Declared, M. Prins Grant/Research support from: Gilead Sciences provided the study medication, O. AMPrEP in HTEAM: None Declared.