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Hepatitis C testing and treatment initiations in the United States dropped by 31% at the beginning of the COVID-19 pandemic in 2020 and treatment initiations did not recover to previous levels during 2020, an analysis of testing and treatment data published in the journal Clinical Infectious Diseases shows.

Modelling based on these findings, presented last month at the 2022 Conference on Retroviruses and Opportunistic Infections, indicates that if the reduction in treatment initiation was sustained for at least two years, the number of deaths due to hepatitis C would be almost twice as high than if the reduction in treatment initiation only lasted one year.

The study assessed hepatitis C testing and treatment activity in the United States from a national database that integrates data on laboratory testing and prescriptions.

Antibody tests dropped by 37% from March to April 2020. Test numbers rebounded to pre-COVID levels by the end of 2020.

Hepatitis C treatment initiations fell by 31% during the early months of the pandemic but did not recover to pre-COVID levels by the end of 2020.

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Hepatitis C care located within a needle and syringe programme in New York achieved a three times higher cure rate than referral to a patient navigator and linkage to medical care at a harm reduction programme or clinic, a randomised trial in New York City has found.

Improving the uptake of hepatitis C care among people who inject drugs is essential for achieving the elimination of hepatitis C, especially in countries where the majority of people with hepatitis C are current drug users.

Offering care in services with low barriers to entry, where service users can walk in without an appointment and also obtain methadone maintenance, has been shown to encourage the uptake of treatment among people who inject drugs.

The study, carried out at the Lower East Side Harm Reduction Center in Manhattan, was designed to test whether offering hepatitis C treatment through a ‘low threshold’ drugs service resulted in better cure rates than linking people to existing hepatitis C care in medical facilities.

People in the accessible-care arm were significantly more likely to achieve a sustained virological response (cure) than people in the standard-care arm (67% vs 22%), due to a much higher rate of linkage to care. People in the accessible-care arm were more likely to be referred to a hepatitis C clinician (92% vs 44%), more likely to attend the first clinical visit (86% vs 37%), to complete baseline laboratory testing (86% vs 31%) and start treatment (78% vs 26%).

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Liver fibrosis in people with HIV in low- and middle-income countries was more often attributable to metabolic disorders than viral hepatitis, a six-country comparative study has found.

The findings, presented last month at the 2022 Conference on Retroviruses and Opportunistic Infections, suggest that prevention of type 2 diabetes and obesity will be critical for avoiding a growing burden of severe liver disease in people living with HIV as they age.

Screening for liver disease was carried out by Fibroscan transient elastography and showed that 11% had F2-F4 fibrosis, while 31% had steatosis. Prevalence of both conditions was highest in Brazil and India, where over 40% had steatosis and approximately 20% had fibrosis.

The prevalence of viral hepatitis was relatively low compared to cohorts of people with HIV in Europe and Asia: 4.5% had hepatitis B and 3.4% had hepatitis C.

In the multivariable analysis, obesity and type 2 diabetes were each associated with a 2.5-fold increase in the risk of fibrosis, while obesity raised the risk of steatosis fivefold. Type 2 diabetes tripled the risk of steatosis. Dyslipidemia and hypertension did not increase the risk of fibrosis or steatosis.

The researchers calculated what proportion of liver fibrosis in the study population was attributable to the risk factors that proved significant in multivariable analysis (the population attributable fraction). Eighteen per cent of fibrosis was attributable to obesity, 12% to type 2 diabetes, 8% to chronic hepatitis and 3% to hepatitis B.

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Non-alcoholic fatty liver disease or liver fibrosis raised the risk of cardiovascular disease in people with HIV who have either normal body weight or are under 60, Italian and Canadian researchers report in the journal HIV Medicine.

The study investigators say that people with HIV should ideally be screened for non-alcoholic fatty liver disease or referred for screening if they have a raised risk of liver fibrosis on laboratory tests, in order to identify people who may be at higher risk of cardiovascular disease.

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