Objectives: To establish a methodology for evaluating the hepatitis C continuum of care in HIV/HCV co-infected individuals and to characterise the continuum in Europe on 1/1/2015, prior to widespread access to direct-acting antiviral (DAA) therapy.
Methods: Stages included in the continuum were: anti-HCV antibody positive, HCV-RNA tested, currently HCV-RNA positive, ever HCV-RNA positive, ever received HCV treatment, completed HCV treatment, follow-up HCV-RNA test, and cure. Sustained virologic response (SVR) could only be assessed for those with a follow-up HCV-RNA test, and was defined as a negative HCV-RNA result measured more than 12 or 24 weeks after stopping treatment.
Results: Following stages of the HCV continuum of care were defined: anti-HCV positive (n=5173), HCV-RNA tested (4207/5173; 81.3%), currently HCV-RNA positive (3179/5173; 61.5%), ever HCV-RNA positive (n=3876), initiated HCV treatment (1693/3876; 43.7%), completed HCV treatment (1598/3876; 41.2%), follow-up HCV-RNA test to allow SVR assessment (1195/3876; 30.8%), and cure (629/3876; 16.2%). The proportion that achieved SVR was 52.6% (629/1195). There were significant differences between regions at each stage of the continuum (p<0.0001).
Conclusions: In the proposed HCV continuum of care for HIV/HCV co-infected individuals we found major gaps at all stages, with almost 20% of anti-HCV positive individuals having no documented HCV-RNA test and a low proportion achieving SVR, in the pre-DAA era.