Netherlands: Targeting MSM with HIV: Treatment as Prevention in the Netherlands

The Dutch government has been taking comprehensive steps to deal with HCV. In November 2015, they ruled to treat all patients with HCV, regardless of age, cirrhosis or fibrosis status, risk profile, injection drug use status or sexual orientation. As part of the national HIV guidelines, all individuals with HIV are screened for hepatitis C. The strategies go hand-in-hand, with one overarching aim: treatment as prevention. The goal is to stop transmission of HCV cold. Because men who have sex with men (MSM) with HIV are at the highest risk for transmitting the disease, they placed particular emphasis on testing and treating that population.

Anne Boerekamps, MD, of Erasmus University Medical Center in Rotterdam, the Netherlands, spoke with HCV Next about the Dutch approach, the relevant data, and other topics associated with screening and treating MSM. Her comments are followed by some of the empirical evidence showing the reasons for and success of these interventions.

Why did you choose MSM with HIV to screen, and not another sub-population of patients with HCV?

In the Netherlands, we screen a lot of patient groups, not only HIV-positive MSM. But we choose to do our research on HIV-positive MSM because they visit the hospital twice a year and the incidence of HCV in this risk group is high. When patients end up in HIV care in the Netherlands, they are screened once for HCV antibodies, and twice a year we look at their liver enzymes. When these levels are elevated or if there is clinical suspicion, we do further testing. 

What we saw was that in 2015 about 5% of MSM with HIV were coinfected with HCV. That is why we decided to screen this population of MSM. We generally screen subpopulations of the highest risk groups, including IV drug users and baby boomers.

Was there any opposition to this decision among the medical community?

No. People are not against screening in the medical community or even among the general population. In the Netherlands, we are very aware of the ongoing epidemic. There was no division in the medical community. In fact, once a year, we have a national HCV day. At this meeting, we talk with all parties — GPs, sexual health clinics, medical specialists and of course the patient groups — about how to eliminate the infection from our country. This is maybe the most important aspect, because you need to collaborate to eliminate. We know that it may be impossible, but there is momentum. Read more via Healio