Clinical Scorecard: Significant Decrease in Coinfection Rates of HIV and HCV in Iceland After Implementation of the TraP HepC National Hepatitis C Elimination Initiative
At a Glance
Category
Detail
Condition
HIV and Hepatitis C Virus (HCV) coinfection
Key Mechanisms
Overlapping transmission modes including injection drug use; accelerated liver disease progression in coinfection; treatment with direct-acting antivirals (DAAs) replacing interferon-based therapies
Target Population
People with HIV (PWH), especially those coinfected with HCV
Care Setting
Nationwide public health program in Iceland integrating prevention, testing, harm reduction, and unrestricted access to DAAs
Key Highlights
Implementation of the TraP HepC program in Iceland led to an >85% decrease in HIV/HCV coinfection prevalence from 2016 to 2020.
DAA treatment era (2016–2020) achieved 88% cure rates compared to 45% in the interferon era (2000–2015).
High HCV reinfection rates (9.35/100 person-years) persist, primarily linked to injection drug use, necessitating ongoing prevention and early treatment.
Guideline-Based Recommendations
Diagnosis
Prompt diagnosis and linkage to care are critical for HIV/HCV coinfected individuals.
Routine HCV antibody and RNA testing among people with HIV, especially those with injection drug use history.
Management
Use of direct-acting antivirals (DAAs) as first-line treatment for HCV in coinfected individuals.
Unrestricted access to DAAs to maximize treatment uptake and cure rates.
Integration of harm reduction strategies including needle and syringe programs and opiate agonist therapy.
Monitoring & Follow-up
Regular follow-up to detect HCV reinfection, particularly in high-risk groups such as people who inject drugs.
Monitoring sustained virologic response at 12 weeks post-treatment (SVR12) to confirm cure.
Risks
High risk of HCV reinfection after cure, especially among injection drug users.
Potential drug interactions between HIV and HCV therapies require careful management.
Patient & Prescribing Data
People with HIV coinfected with HCV in Iceland from 2000 to 2020
DAA treatment significantly improved cure rates (88% vs 45% with interferon) and contributed to a substantial reduction in coinfection prevalence; however, reinfection remains a challenge requiring ongoing prevention and treatment access.
Clinical Best Practices
Implement nationwide treatment-as-prevention programs combining early diagnosis, harm reduction, and unrestricted DAA access.
Prioritize treatment of coinfected individuals to reduce liver-related morbidity and mortality.
Maintain robust surveillance for reinfection and provide continuous prevention services targeting injection drug use.
Collaborate across specialties and institutions to achieve WHO elimination targets.
