Hepatitis C Virus (HCV) Clearance Cascade for Persons With Human Immunodeficiency Virus (HIV)/HCV Coinfection Using Health Department Surveillance Data Among 7 US Jurisdictions Highlights the Role of HIV Care Engagement

Background Persons with human immunodeficiency virus (HIV) coinfected with hepatitis C virus (HCV) experience worse health outcomes compared to HCV-monoinfected individuals and can benefit from highly effective direct-acting antivirals (DAAs). Despite their availability, DAAs have not been comprehensively implemented to achieve the 80% national viral cure target. Understanding the HCV care continuum for people with HIV is critical for addressing public health intervention gaps. We worked with 7 diverse health department jurisdictions to implement a standardized Centers for Disease Control and Prevention HCV clearance cascade for coinfected people with HIV. Methods We developed data collection tools upon matching HIV and HCV surveillance datasets, automating HCV clearance cascade generation for a cohort of coinfected persons from 31 December 2019 through 31 December 2021. We conducted multivariable analysis to assess progress toward elimination targets and identify risk factors for poor HCV clearance. Results Combined clearance cascades showed 31.6% viral cure/clearance at baseline and 42.4% at the study's end. Black/African American persons exhibited significantly lower odds of cure/clearance compared to White individuals (adjusted odds ratio [aOR], 0.83; P = .03). Increased viral cure/clearance rates were seen in men who have sex with men compared to heterosexuals (aOR, 1.46; P = .004). Those who had HIV viral suppression were more likely to have cleared HCV (aOR, 2.19; P < .0001). Conclusions HCV viral cure/clearance rates in this coinfected population, while better compared to published rates for persons with HCV monoinfection, remain far below strategic national target goals. Optimal HIV care engagement was associated with improved HCV outcomes, suggesting that public health strategies that build on established clinical models and public health infrastructure for HIV can be leveraged to improve HCV outcomes.