THE IMPACT of COVID-19 on HCV MICRO-ELIMINATION in MSM in GERMANY

Background: Men who have sex with men (MSM) have been identified as one subgroup with continuous HCV transmission and as a target for HCV micro-elimination efforts. We assess newly acquired HCV among MSM in Germany since the introduction of directly-acting antiviral agents (DAAs). Methods: The German NoCo cohort consists of patients from six German HIV and hepatitis treatment sites providing care for more than 8000 HIV-positive MSM, and serving as primary care providers and HIV pre-exposure prophylaxis (PrEP) sites. Patients who were diagnosed with recently acquired HCV infection since 2014 were enrolled and are followed-up. Virologic data, HIV and HCV treatment data, risk factors and behavior as well as liver disease assessment is acquired regularly. Results: Between January 2014, and October 2021, 237 MSM with recently acquired HCV infection were included. A majority were Caucasian (95%), and mean age was 45.3 years (standard deviation, SD, 9.57). At HCV diagnosis, median ALT level was 224 U/L (interquartile range, IQR, 86-521), and median HCV viral load was 475,000 IU/mL (IQR 66,955-3,005,882). The most prevalent HCV genotype were 1a (58.7%), and 4d (16%). The risk factors for HCV acquisition were as follows: MSM: 92.4%, intravenous drug use: 2.95%, intranasal drug use: 0.8%, other: 0.4%, unknown: 7.2%. A subgroup of 21 (8.9%) MSM were not co-infected with HIV, of whom 15 (71.4%) were using PrEP. Anti-HCV treatment with DAAs was documented in 165 patients (71.7%), 18 (7.8%) had a spontaneous clearance, and in 47 patients (20.4%) treatment was not started. DAAs were initiated a median 6.6 months (IQR 4 to 9.3) after diagnosis;all treated patients achieved a sustained virologic response (SVR), or treatment was still ongoing (16%). Between 2014-2019 27-36 patients were diagnosed with recently acquired HCV annually. In relation to all HIV-positive MSM under care, the incidence was 0.33-0.39% per year with no significant change over time. In 2020, a decline in HCV incidence to 0.28% was observed. In 2021 HCV incidence dropped to 0.02%. In the same period, the number of patients seen in the centers remained stable, and routine HCV testing returned to pre-pandemic levels by the end of 2020. Conclusion: The German NoCo cohort demonstrated stable HCV incidence rates despite a broad use of DAAs. In 2021, however, micro-elimination goals were met, possibly due to behaviour changes related to the SARS-CoV-2 pandemic and associated containment measures.

PrEP ROLLOUT and COVID-19 ARE IMPACTING COMMUNITY-BASED TESTING for HIV & OTHER STIs

Background: Published clinical and epidemiological data on individuals undergoing anonymous testing for sexually transmitted diseases (STI) in Germany are sparse. Here we report annual results of STI screenings and survey data from a large community based STI testing Checkpoint in Cologne, Germany in light of increased PrEP roll-out and the COVID-19 pandemic. Methods: From January 2017 to December 2020, data on STI screening, clinical, demographic, sexual information was anonymously recorded for individuals attending the Checkpoint in Cologne. Visitors were screened for HIV, syphilis, chlamydia, gonorrhea and hepatitis C using point of care testing kits. Positive tests were validated. Results: Overall, screening was performed on 15,153 visitors aged 16 to 85 years. Three main reasons were identified: recent HIV risk situation (40%), routine testing (23%), new relationship (21%). The largest visitor group represented MSM with a mean frequency of 40% across all years, followed by MSW (28%) and WSM (22%). Annual visitor numbers increased from 3,838 in 2017 by +3% and +6% for years 2018 and 2019, respectively. However, these figures declined by 40% in 2020 (COVID-19 lockdown). Frequency of MSM visitors declined from 46% in 2017 to 42%, 38%, and 35% in 2018 to 2020, respectively. In contrast, visitor numbers increased for all other groups from 2017 to 2020, with the highest relative change observed for WSW (+94%), followed by MSW (+25%) and MSW (+16%). Annual number of visitors screened for HIV declined from 55% in 2017 to 42% in 2020, with increasing test frequencies for chlamydia and gonorrhoea (17% in 2017 to 29% in 2020) and for HCV (4% in 2017 to 9% in 2020). Syphilis screening frequency remained constant at approximately 19% annually. MSM had the highest disease frequency but MSW and WSM showed a continuous increase in chlamydia infections from 2017 to 2020 (from 20% to 30% and 13% to 22%, respectively). Number of MSM visitors on PrEP increased from 2017 onwards, with +46% and +52% for years 2018 and 2019, and 7% for 2020 (COVID-19 lockdown). Conclusion: Checkpoint was able to detect relevant STIs in 5% of all visitors thereby underling the importance of community-based testing sites particularly with increased PrEP roll-out and despite COVID-19 lockdown restrictions. Still, MSM remain at highest risk for contracting HIV highlighting the continuous need for educational activities as well as low-threshold and cost-free STI screening capacities.

Low-threshold SARS-CoV-2 testing facility for hospital staff: Prevention of COVID-19 outbreaks?

BACKGROUND: The ongoing global SARS-CoV-2 pandemic has caused over 4.7 million infections greatly challenging healthcare workers (HCW) and medical institutions worldwide. The SARS-CoV-2 pandemic has shown to significantly impact mental and physical health of HCW. Thus, implementation of testing facilities supporting HCW are urgently needed. METHODS: A low-threshold SARS-CoV-2 testing facility was introduced at the University Hospital Bonn, Germany, in March 2020. Irrespective of clinical symptoms employees were offered a voluntary and free SARS-CoV-2 test. Furthermore, employees returning from SARS-CoV-2 risk regions and employees after risk contact with SARS-CoV-2 infected patients or employees were tested for SARS-CoV-2 infection. Pharyngeal swabs were taken and reverse transcription polymerase chain reaction for detection of SARS-CoV-2 was performed, test results being available within 24 h. Profession, symptoms and reason for SARS-CoV-2 testing of employees were recorded. RESULTS: Between 9th March and April 30, 2020, a total of 1510 employees were tested for SARS-CoV-2 infection. 1185 employees took advantage of the low-threshold testing facility. One percent (n = 11) were tested positive for SARS-CoV-2 infection, 18% being asymptomatic, 36% showing mild and 36% moderate/severe symptoms (missing 10%). Furthermore, of 56 employees returning from SARS-CoV-2 risk regions, 18% (10/56) were tested SARS-CoV-2 positive. After risk contact tracking by the hospital hygiene 6 patient-to-employee transmissions were identified in 163 employees with contact to 55 SARS-CoV-2 positive patients. CONCLUSION: In the absence of easily accessible public SARS-CoV-2 testing facilities low-threshold SARS-CoV-2 testing facilities in hospitals with rapid testing resources help to identify SARS-CoV-2 infected employees with absent or mild symptoms, thus stopping the spread of infection in vulnerable hospital environments. High levels of professional infection prevention training and implementation of specialized wards as well as a perfectly working hospital hygiene network identifying and tracking risk contacts are of great importance in a pandemic setting.

COVID-19 research: an opinion piece.

The unprecedented global scale of COVID-19 globally has triggered a race to discover interventions to reduce associated morbidity and mortality and rapid release of research findings prior to any degree of critical review. As with previous novel infection outbreaks, antiretrovirals are just one drug class that has been held up as a potential strategy for prophylaxis and treatment with scant evidence and risk of harm. Here we summarize the evidence for antiretrovirals to treat COVID-19 and, as a drug that has also been studied in HIV, hydroxychloroquine, and flag some of the pitfalls of using therapies that have not been evaluated robustly.