Abstract
BACKGROUND: HIV and HCV share similar routes of infection. Individuals carrying both viruses experience a faster progression of the liver disease. We have analyzed people with new HIV-1 diagnoses in Germany for active or resolved HCV infection for over ten years. The time period covers the introduction of direct acting antivirals (DAA), a paradigmatic shift in HCV therapy. METHODS: A central component of the HIV surveillance in Germany is the notification of new diagnoses. Residual blood samples from 16,539 people with new HIV-1 diagnoses reported between 2009 and 2019 were examined for HCV antigen and/or antibodies. Reactive cases were further investigated for active or resolved HCV infection by RT-qPCR. The results were analyzed with socio-demographic information from the notification forms. RESULTS: The study includes samples from 48.0% of all notified HIV-1 diagnoses. The seroprevalence of cases with HCV antigen, antibodies or both, representing active and resolved infections was 6.2% with stable seroprevalence. The average proportion of resolved infections among those was 33.0% with a significant increase since the introduction of DAAs in 2012 (p(Trend_2012-2019) = 0.028) reaching 48.2% in 2019. The highest proportion of active and resolved cases (73.7%) was found in people who inject drugs (PWIDs). This transmission group had the lowest percentage of resolved infections with 29.4%. The proportion of active and resolved cases in persons with heterosexual mode of transmission (HET) and in men who have sex with men (MSM) was 3.8% and 2.6%, respectively. The peak percentage of resolved infections was found in MSM (40.0%), followed by HET (36.6%). The proportion of active and resolved cases among individuals with non-German origin was higher than in people with German origin (8.8%, versus 4.3%; p < 0.001) and the proportion of resolved HCV infections lower (27.8% versus 34.0%; p = 0.027). CONCLUSIONS: The proportion of resolved HCV infections among people newly diagnosed with HIV-1 increased after the introduction of DAAs in Germany. The high prevalence and the low proportion of resolved HCV infections reveal that unmet diagnostic and therapeutic needs exist among PWIDs. The higher proportion of active and resolved cases among individuals of non-German origin particularly requires greater public health attention.