Co-EC Study: Eliminating hepatitis C/HIV coinfection

Past project

The co-EC study aimed to eliminate hepatitis C/HIV coinfection among gay and bisexual men through scale up treatment of Hepatitis C in primary care and hospital settings. This study involved an open label, non-randomised clinical trial of hepatitis C treatment for people with HIV coinfection.

Objective

Hepatitis C virus (HCV) infection is a significant health issue among individuals with human immunodeficiency virus (HIV) infection and has been associated with more rapid progression to HCV-related liver disease and increased risk for cirrhosis and liver cancer. In Victoria Australia, the highest prevalence of HCV/HIV co-infection is in gay and bisexual men.

The advent of directly acting antiviral (DAA) treatment provides us with a unique opportunity to increase the number of people accessing hepatitis C treatment. In most cases, new DAA treatment offers shorter treatment times and fewer side effects than previous HCV treatment.

Importantly it is likely that the treatment could be administered in the primary health care setting improving treatment capacity and accessibility, whilst potentially reducing treatment costs.

Timeline

The study ran for 36 months, including 18 months for recruitment and treatment and 12 months follow-up, from April 2016–2019.

Approach

Treatment involved any combination of hepatitis C antiviral therapy approved for use in Australia appropriate for the participants’ hepatitis C genotype. All participants received open label hepatitis C treatment selected at the decision of their treating clinicians.

Treatment was based at six clinics in Melbourne, including both HIV primary care clinics and specialist clinics:

Alfred Hospital
Melbourne Sexual Health Centre, Carlton
Prahran Market Clinic
Prahran
Royal Melbourne Hospital, Parkville
Centre Clinic, St Kilda
Northside Clinic, North Fitzroy.

Community impact

This study offered proof of concept that scaling up treatment could lead to elimination of HCV/HIV co-infection in gay and bisexual men by treating prevalent infection thereby reducing new primary infections and re-infection.