Background The scale-up of HCV treatment for HIV/HCV coinfected individuals is occurring, the majority with a history of injecting drug use.

Purpose We assess the implications for achieving the World Health Organisation HCV incidence elimination target (80% reduction from 2015–2030) among HIV-infected (HIV+) people who inject drugs (PWID) and all PWID, using dynamic modelling.

Material and methods A joint HIV and HCV transmission model among PWID was based on published data and the HERACLES cohort (prospective cohort of HIV/HCV coinfected individuals in care from 2015–2017). The model was stratified by HIV stage, HCV stage and PWID status (young PWID (<10 years’ injecting), old PWID (>10 years’ injecting), ex PWID). We simulated: 45%/60% chronic HCV prevalence and 20%/40% HIV prevalence among PWID injecting for <10 years and >10 years, respectively, 54% chronic HCV among HIV +ever PWID (PWID +ex PWID). We assumed HCV treatment among diagnosed coinfected ever-PWID of 10.5%/year from 2004–2014, and 33%/year from 2015 (from HERACLES). We projected the impact of current treatment, and scaled-up treatment (among HIV +PWID or all PWID) from 2018 on HCV prevalence/incidence among HIV +PWID and all PWID.

Results We projected that 28% and 32% of HCV +PWID and HCV +ex PWID, respectively, were HIV/HCV coinfected in 2015. Current treatment rates could reduce the number of diagnosed coinfected PWID by 75% from 2015–2030. However, this would only reduce HCV incidence by a relative 25% and 16% among HIV +PWID and all PWID, respectively. If all coinfected PWID were diagnosed and treated annually from 2018, this could reduce chronic HCV prevalence by 74% among HIV+ PWID by 2030, but only halve the incidence. Greater impact could be achieved through scaling-up treatment to all PWID.

Conclusion HCV elimination among HIV +PWID will not be achieved by treating coinfected PWID alone: efforts should focus on HCV diagnosis and treatment among both coinfected and monoinfected PWID. Scaling-up treatment to all PWID.

References and/or acknowledgements No conflict of interest.