International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC)

The International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC) is an international consortium of cohort studies of people with HIV who are at risk of hepatitis C virus (HCV) infection or infected with HCV. InCHEHC has been specifically designed to assess progress towards hepatitis C virus elimination as a public health threat among people with HIV.

In 2013, HCV treatment was transformed through the availability of all-oral direct-acting antiviral (DAA) therapy. In as little as 8–12 weeks of treatment, >95 per cent of patients are cured of HCV, including HIV/HCV-coinfected individuals whose previous cure rates were <50 per cent.

In 2016, the World Health Organization (WHO) set targets for the elimination of hepatitis C as a public health threat by 2030, including an 80 per cent reduction in HCV incidence and 65 per cent reduction in HCV-related mortality. This is a major undertaking given the estimated 59 million people infected in 2020. New absolute targets to guide HCV elimination validation were added in 2021.

PHIV are a key population for HCV elimination, as HCV infection is both more common among PHIV and liver disease progresses more rapidly than in individuals without HIV. HIV/HCV co-infection results in higher rates of HCV-related mortality relative to those with HCV alone. Moreover, regular clinic visits for HIV care provide opportunities for (early) HCV diagnosis and treatment in this group.

The International Collaboration of Hepatitis C Elimination in HIV Cohorts (InCHEHC) was established in 2018 to track progress and guide policy on elimination of HCV in PHIV.

Timeline

• 2017: first meeting of international groups interested in forming a consortium on hepatitis C elimination in people with HIV that led eventually to InCHEHC.
• 2018: inaugural meeting of InCHEHC and publication of first collaborative paper.
• 2020: first data merge.
• 2022: publication of first manuscript based on merged data.
• 2024: second data merge.

Approach

InCHEHC’s first project examined the HCV care cascade in people living with HIV in five countries (Australia, Canada, France, the Netherlands, and Switzerland). Since then, cohorts from Spain and Italy have joined the collaboration. The first data merge of individual-level data was conducted in 2020-2021 and included >100,000 participants, and the second individual-level data merge was conducted in 2024. Cohorts included in InCHEHC were chosen due to the availability of broad access to DAA therapies in their respective country or jurisdiction, while still having differences in HCV healthcare-related policies (e.g., HCV RNA testing), a large coverage of PHIV or a representative sample of PHIV in their setting, long-standing cohort data among PHIV including HCV-related clinical data collection, and/or detailed HCV-related behavioural data.

Community impact

This large international consortium provides empirical evidence on the impact of broad access to hepatitis C treatments on hepatitis C incidence, and hepatitis C related morbidity and mortality.