Significant Decrease in HIV/HCV Coinfection Rates in Iceland Post TraP HepC
Overview
The TraP HepC program in Iceland, initiated in 2016, led to an over 85% reduction in HIV/HCV coinfection rates by 2020, primarily due to widespread use of direct-acting antivirals (DAAs). Cure rates improved significantly in the DAA era compared to the interferon era, although reinfection rates remain a concern.
Background
HIV and hepatitis C virus (HCV) coinfection is a major global health issue, with overlapping transmission routes such as injection drug use. Coinfected individuals face accelerated liver disease progression and higher liver-related mortality. Direct-acting antivirals (DAAs) have revolutionized HCV treatment, achieving high cure rates even in coinfected patients. Iceland's TraP HepC program aimed to eliminate HCV by scaling up prevention, testing, and unrestricted access to DAAs.
Data Highlights
Parameter
Interferon Era (2000–2015)
DAA Era (2016–2020)
Number of HIV/HCV Coinfected Individuals
Steady increase, peaked at 41 in 2016
Decreased by >85% to 6 by 2020
Active HCV Infections Diagnosed
29
60
Treatment Initiations
29
60
Cures Achieved
13 (45%)
53 (88%)
HCV Reinfection Rate
Not specified
9.35 per 100 person-years
Key Findings
The total number of HIV/HCV coinfected individuals peaked at 41 in 2016 and dropped by over 85% to 6 by 2020 after TraP HepC implementation.
Cure rates improved significantly from 45% in the interferon era to 88% in the DAA era (P < .001).
A total of 84 active HCV infections, including reinfections, were diagnosed, leading to 81 treatment initiations and 66 cures.
The HCV reinfection rate among coinfected individuals was 9.35 per 100 person-years, primarily linked to injection drug use.
Despite reduced incidence, high reinfection rates highlight the need for ongoing prevention, early diagnosis, and easy access to DAAs.
Clinical Implications
The TraP HepC program demonstrates that widespread DAA access combined with comprehensive prevention strategies can dramatically reduce HIV/HCV coinfection rates. Clinicians should prioritize early diagnosis and linkage to care, maintain vigilance for reinfections especially in high-risk groups, and ensure continuous harm reduction services to sustain elimination efforts.
Conclusion
Iceland’s TraP HepC initiative markedly decreased HIV/HCV coinfection prevalence through effective DAA treatment and prevention strategies. Continued efforts are essential to address reinfection risks and maintain progress toward HCV elimination.
References
Björnsson et al. 2022 -- Significant Decrease in Coinfection Rates of HIV and HCV in Iceland After Implementation of the TraP HepC National Hepatitis C Elimination Initiative
