HCV Cure/Clearance Rates Below National Target Goals in Patients Coinfected With HIV

Coinfection of HIV and hepatitis C virus (HCV) have worse clinical outcomes than those with HCV alone, making curing HCV in this population vital. However, according to a new study published in Open Forum Infectious Diseases,¹ the rate of clearance or cure of HCV in those coinfected with HIV is still below the strategic national target goals, even though the rates are higher in this population compared with those with HCV alone.

Direct-acting antivirals (DAAs) are a means of curing HCV with an efficacy of more than 95% for those who are either coinfected with HCV and HIV or have HCV alone. Because of this, strategies have been developed to help eliminate HCV through testing and treatment. As 21% of those with HIV also have HCV, it is incredibly important to target this population for treatment to minimize the potential long-term effects.² This study aimed to assess how HCV was treated in those with HCV and HIV simultaneously.

Those with HIV and HCV coinfection were more likely to have cure/clearance but the rates were still lower than the recommended rate | Image credit: RAJCREATIONZS - stock.adobe.com

Seven health department jurisdictions were chosen for this study based on their surveillance databases of patients with HIV and laboratory result databases for HCV. Arizona Department of Health Services, Connecticut Department of Public Health, Florida Department of Health in Orange County, Kentucky Department of Health, Michigan Department of Health and Human Services, Southern Nevada Health District, and Puerto Rico Department of Health were all included in the study.

All jurisdictions completed a survey of 215 questions regarding their data systems, HIV and HCV surveillance programs, data matching, and personnel. This data was used to outline minimum requirements to create clearance cascades for HCV. All data were aggregated by jurisdiction. Patients with HIV/HCV coinfection were included in the baseline cohort based on their prevalent eHARS by December 31, 2019. Data were collected through December 31, 2021, at intervals of 6 months. Test results for HCV were used to assess care status.

Clearance cascade included 5 stages: ever infected; viral testing; initial infection; cured or cleared; and persistent infection. This study aimed to assess viral testing and cure/clearance outcomes.

There was a 6.6 times greater number of participants with HCV compared with HIV with 10.2% of those with HIV being coinfected with HCV compared with 1.5% of those with HCV coinfected with HIV. A total of 29.9% of those with HIV and 36.7% of those who were coinfected were Hispanic/Latino, and men made up the majority of both the HIV (78.5%) and coinfected groups (75.2%); men made up 61.5% of the HCV group.

The number of coinfected at baseline was 7227, which decreased to 6562 by the end of the analysis when excluding deceased individuals and individuals who were out of jurisdiction. Viral clearance increased from 31.6% at baseline to 42.4% by the end of the study, with viral testing also increasing slightly from 63.4% at baseline to 65.5%.

The viral testing rate was slightly higher in Black individuals (72.8%) compared with other participants. Those older than 45 years had clearance rates above 42%. Undetectable viral loads for HIV were associated with higher clearance rates when compared with those who had detectable viral loads (44.5% vs 27.2%). Higher HCV viral testing and clearance rates were associated with shorter time since the last HIV test.

Black participants had lower odds of HCV clearance when compared with White participants (adjusted OR [aOR], 0.83), and the HIV risk factor of being a man who has sex with men was associated with an increased odds of clearance (aOR, 1.46) when compared with those who had heterosexual contact. Odds of clearance were higher in those with undetectable HIV viral loads (aOR, 2.19).

There were some limitations to this study. Individual-level results could not be identified due to the aggregate nature of the data. The data for HCV surveillance was incomplete at times, which could lead to an underestimation of the rates of cure/clearance. Treatment data was not included, and no data on treatment was available for those who were not cured/cleared. This study was conducted during the COVID-19 pandemic, which could have affected the results.

“While viral clearance rates above 40% in this coinfected group surpass those for monoinfected persons, these still fall short of the 80% goal set by national strategic guidelines,” the authors wrote. “Given the poorer health outcomes among persons with coinfection, public health strategies that build on engagement in HIV care through established clinical models and public health infrastructure can be leveraged to improve HCV outcomes.”

References

1. Wegener M, Brooks R, Nichols L, Altice FL, Villanueva M. Hepatitis C virus (HCV) clearance cascade for persons with human immunodeficiency virus (HIV)/HCV coinfection using health department surveillance data among 7 US jurisdictions highlights the role of HIV care engagement. Open Forum Infect Dis. 2025;12(8):ofaf412. doi:10.1093/ofid/ofaf412

2. HIV and hepatitis C. Hivinfo.NIH.gov. Updated March 31, 2025. Accessed August 13, 2025. https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-and-hepatitis-c