Direct-acting antivirals (DAAs) have been shown to cure hepatitis C virus (HCV) infection in 95% of patients. Modelling studies have predicted that universal HCV treatment will lead to a decrease in the incidence of new infections but currently there is a lack of real-life data. The incidence of HCV among Dutch HIV-coinfected men who have sex with men (MSM) has been high for >10 years. In 2015 DAAs became available to all Dutch HCV patients and resulted in a rapid treatment uptake in HIV-coinfected MSM. The authors were interested in whether this uptake led to a decrease in the incidence of HCV infections. They conducted two prospective studies of treatment for acute HCV in 17 Dutch HIV centres covering 76% of the total HIV-coinfected MSM population in care in the Netherlands. Patients were recruited in the years preceding and succeeding unrestricted DAA availability. The authors found that the incidence of acute HCV infection decreased from 93 infections during 8290 person-years of follow-up (PYFU) in 2014 (11.2/1000 PYFU) to 49 during 8961 PYFU in 2016 (5.5/1000 PYFU). The incidence rate ratio of 2016 compared with 2014 was 0.49 (95% CI 0.35–0.69). However, there was a simultaneous significant increase in the percentage positive with syphilis (+2.2%) and gonorrhoea (+2.8%) among HIV-infected MSM seen in sexual health clinics across the Netherlands and therefore the reduction in incidence is not due to a reduction in risk behaviour. Therefore unrestricted DAA availability in the Netherlands was followed by a 51% decrease in acute HCV infections among HIV-infected MSM.
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