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

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 2017 to track progress and guide policy on elimination of HCV in PHIV.

2017-2025

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, a cohort from Spain has joined the collaboration. The first data merge of individual-level data was conducted in 2020-2021 and included >100,000 participants. A new data merge is expected in 2023. 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.

This large international cohort will assess progress towards the WHO elimination targets during the target period (2016-2030) and identify areas for refinement of policy and practice.

All-cause mortality before and after DAA availability among people living with HIV and HCV: An international comparison between 2010 and 2019.

Requena MB, Protopopescu C, Stewart AC, van Santen DK, Klein MB, Jarrin I, Berenguer J, Wittkop L, Salmon D, Rauch A, Prins M, van der Valk M, Sacks-Davis R, Hellard ME, Carrieri P, Lacombe K; InCHEHC Collaboration (2024)
International Journal of Drug Policy

Changes in incidence of hepatitis C virus reinfection and access to direct-acting antiviral therapies in people with HIV from six countries, 2010–19: an analysis of data from a consortium of prospective cohort studies. 

Sacks-Davis R, van Santen DK, Boyd A, Young J, Stewart A, Doyle JS, Rauch A, Mugglin C, Klein M, van der Valk M, Smit C, Jarrin I, Berenguer J, Lacombe K, Requena MB, Wittkop L, Leleux O, Bonnet F, Salmon D, Matthews GV, Guy R, Martin NK, Spelman T, Prins M, Stoove M, Hellard M; on behalf of the InCHEHC Collaboration (2024)
The Lancet HIV

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

van Santen DK, Stewart A, Doyle JS, Stoové MA, Asselin J, Klein MB, Young J, Berenguer J, Jarrin I, Lacombe K, Wittkop L, Leleux O, Salmon D, Bonnet F, Rauch A, Mugglin C, Matthews G, Prins M, Smit C, Boyd A, van der Valk M, Sacks-Davis R, Hellard ME; InCHEHC Study Group.(2024)
International Journal of Epidemiology 

Reasons for not commencing direct-acting antiviral treatment despite unrestricted access for individuals with HIV and hepatitis C virus: a multinational, prospective cohort study

Isfordink CJ, Boyd A, Sacks-Davis R, van Santen DK, Smit C, Martinello M, Stoove M, Berenguer J, Wittkop L, Klein MB, Rauch A, Salmon D, Lacombe K, Stewart A, Schinkel J, Doyle JS, Hellard M, van der Valk M, Matthews GV, InCHEHC study group (2023)
The Lancet, Public Health

Treatment as prevention effect of direct-acting antivirals on primary hepatitis C virus incidence: Findings from a multinational cohort between 2010 and 2019.

van Santen DK, Sacks-Davis R, Stewart A, Boyd A, Young J, van der Valk M, Smit C, Rauch A, Braun DL, Jarrin I, Berenguer J, Lazarus JV, Lacombe K, Requena MB, Wittkop L, Leleux O, Salmon D, Bonnet F, Matthews G, Doyle JS, Spelman T, Klein MB, Prins M, Asselin J, Stoové MA, Hellard M, InCHEHC study group (2022)
EClinicalMedicine

Linkage and retention in HCV care for HIV-infected populations: early data from the DAA era

Rachel Sacks-Davis, Joseph S Doyle, Andri Rauch, Charles Beguelin, Alisa E Pedrana, Gail V Matthews, Maria Prins, Marc van der Valk, Marina B Klein, Sahar Saeed, Karine Lacombe, Nikoloz Chkhartishvili, Frederick L Altice, Margaret E Hellard (2018)
Journal of the International AIDS Society.