Therapy as prevention toward HCV elimination in maintenance hemodialysis: a multi-center, prospective cohort study

Background. The World Health Organization has established interim guidance for hepatitis C virus (HCV) elimination. We aimed to prove the concept of treatment as prevention by conducting a prospective HCV elimination program for hemodialysis (HD) patients.Methods. A universal HCV screen was launched in 22 HD centers in 2019. HCV-viremic patients were linked to care with direct-acting antivirals (DAAs). The second screen was performed in 2021 to evaluate the effect of link-to-care in lowering the prevalence of HCV viremia and the incidence of HCV new/re-infections.Results. Of 2336 patients enrolled in the first screening in 2019, 320 (13.7%) were seropositive for anti-HCV and 181 (7.7%) were HCV-viremic. Of 152 patients successfully linked to treat with DAA, 140 (92.1%) patients achieved a sustained virological response. Of them, 1733 patients participated in the second surveillance. Five anti-HCV-negative patients experienced anti-HCV seroconversion. Of 119 DAA-cured patients and 102 spontaneous HCV clearance patients, none had HCV reinfection. The annual incidence of HCV new infection was 0.1%. Sixty-one of the 620 (9.8%) newly enrolled patients were anti-HCV-seropositive in the second survey. The overall HCV-viremic rate decreased from 7.7% in 2019 to 0.6% (15/2353) in 2021. At the institutional level, 45.5% (10/22) eradicated HCV and 82% (18/22) of HD units had no HCV new infections or reinfections.Conclusions. The link-to-care project proved the concept of treatment as prevention by which HCV microelimination helps to prevent reinfection and new infections in the HD population.

Automated summary

The study demonstrated the concept of treatment as prevention by implementing an HCV elimination program for hemodialysis patients. Universal HCV screening and prompt treatment with DAAs effectively reduced the prevalence of HCV viremia and prevented reinfection and new infections.