The Status of Hepatitis C Microelimination Among People Living with HIV in Central and Eastern Europe in 2022—Data from Euroguidelines in Central and Eastern Europe Network Group
by
Agata Skrzat-Klapaczyńska
1,*, 
Sergii Antoniak
2,
Svitlana Antonyak
2,
Konstantinos Protopapas
3,
Antonios Papadopoulos
3,
Daniela Maric
4,
Botond Lakatos
5,
Antonija Verhaz
6,7,
Milan Zlamal
8,
Zofia Bartovska
8,
Milena Stefanovikj
9,
Gordana Dragovic
10,
Arjan Harxhi
11,
David Jilich
12,
Kerstin Aimla
13,
Lilia Cojuhari
14,
Justyna Kowalska
1 and
Josip Begovac
15 1
Department of Adults’ Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
2
Gromashevsky Institute of Epidemiology and Infectious Diseases within NAMS of Ukraine, Kyiv, Ukraine
3
4th Department of Internal Medicine, University Hospital "Attikon", National and Kapodistrian University of Athens, Athens, Greece
4
Clinical Center of Vojvodina, Novi Sad, Serbia
5
National Institute of Hematology and Infectious Diseases, Budapest, Hungary
6
Clinic for Infectious Diseases, University Clinical Centre of the Republic of Srpska, Banja Luka, the Republic of Srpska
7
Department for Infectious Diseases, Faculty of Medicine, University, Banja Luka, Bosnia and Herzegovina
8
Department of Infectious Diseases, First Faculty of Medicine, Charles University and Military University Hospital Prague, Czech Republic
9
University Clinic for Infectious Diseases and Febrile Conditions, Skopje, The Republic of North Macedonia
10
Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
11
Infectious Disease Department, Medical University of Tirana, Albania
12
Department of Infectious Diseases, 1st Faculty of Medicine, Charles University in Prague and Faculty Hospital Bulovka, Prague, Czech Republic
13
Tartu University Hospital, Tartu, Estonia
14
Department of Infectious Diseases, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chișinău, Republic of Moldova
15
University Hospital for Infectious Diseases, Zagreb, Croatia
*
Author to whom correspondence should be addressed.
GERMS 2025, 15(2), 144-156; https://doi.org/10.18683/germs.2025.1464
Submission received: 26 May 2025
/
Revised: 29 June 2025
/
Accepted: 30 June 2025
/
Published: 30 June 2025
Abstract
Introduction: The implementation of nationwide viral hepatitis C elimination programs is challenging in Central and Eastern European countries (CEEC). It is reasonable to start by targeting specific populations, such as people living with HIV (PLWH), who are at higher risk of acquiring HCV or developing HCV-related complications. Methods: Euroguidelines in Central and Eastern Europe Network Group consists of experts in the field of infectious diseases from 26 countries in the region. Between April 26th and June 23rd 2023, the group performed an on-line survey consisting of 32 questions. The questionnaire assessed the status of HCV micro-elimination in 2022. Results: Twelve HIV centers from 11 countries responded: Albania, Bosnia and Herzegovina, Croatia, Czech Republic, Estonia, Greece, Hungary, Macedonia, Moldova, Serbia and Ukraine. All centers screen for HCV antibody all PLWH at entry into care. The seroprevalence of anti-HCV was <5% in 5 centers (Albania, Croatia, Serbia, North Macedonia and Hungary), 30.2% in Estonia and 29% in Ukraine, Greece and Moldova had high seroprevalence as well, 15.3% and 15.6% respectively. The prevalence of HCV viremia in antibody-positive PLWH was very high in Greece (85%), while in most other treatment centers it ranged from 4.2% to 38.2%. There is also a screening policy of annual HCV-testing of HCV-antibody negative persons in all centers by either testing all PLWH or those considered at risk. Direct-acting antiviral agents (DAA) were not available in one country (Albania). Among PLWH who entered care in 2022, nine out of 12 ECEE centers reported cases of HCV/HIV coinfection, with five centers indicating that at least 50% of these individuals were HCV-viremic. Conclusions: HCV screening in PLWH followed by access to DAA treatments were available in all but one center. Microelimination of HCV in PLWH in the majority of surveyed HIV treatment centers in CEEC has not been achieved and efforts to reach this goal need to be strengthened.
Introduction
Elimination of hepatitis C virus (HCV) infection became a realistic objective due to effective policies in recent years, non-invasive diagnostic procedures of liver fibrosis and the development of direct-acting antiviral (DAA) medications.[1] However, the HCV screening of at-risk populations, mainly migrants, prisoners, drug users, or men who have sex with men (MSM) remains insufficient.[2] Although the targets and the instruments for HCV elimination have been established, microelimination of HCV in high-risk populations and target groups is a feasible goal that has not yet been attained.[3,4] The World Health Organization (WHO) strategized global viral hepatitis elimination targets in 2015. For HCV, these targets include an 80% reduction in new infections and a 65% reduction in HCV-related mortality between 2015 and 2030.[5] The European Association for the Study of the Liver has also defined the HCV-microelimination strategy, especially in subgroups of people, such as people living with HIV, prisoners, and people who inject drugs.[6] It has been observed that in people living with HIV, HCV can lead to liver cirrhosis and death faster than in the general population.[7] HCV coinfection is a major cause of non-AIDS-related morbidity and mortality in people living with HIV because of reduced or slower CD4+ lymphocyte reconstitution after antiretroviral therapy (ART) introduction.[8]
Treatment of all patients with HCV infection is cost-effective to reduce hepatic and extrahepatic morbidity and mortality. A combination of two or three second-generation DAAs provides a sustained viral response, but it will be not achieved without proper testing in specific groups of potential patients. Moreover, the COVID-19 pandemic has slowed or stopped altogether many hepatitis elimination programs, and it has affected HIV medical care.[9,10] The region of Central and Eastern Europe (CEE) is characterized by differences in the number of patients with HIV/HCV co-infection and insufficient epidemiological supervision in this area. The HCV/HIV coinfection prevalence rages between 3% and 99% in CEE countries.[11] According to the European Centre for Disease Prevention and Control data, in 2016 around 40% of new HIV diagnoses were among MSM, this means that the MSM population is at high risk of high HCV prevalence.[12]
An additional problem is a disproportion in access to proper treatment of HIV and differences in its quality in the CEE region.[13] It is reasonable to start by targeting specific populations, like people living with HIV, who are at higher risk of acquiring HCV or developing HCV-related complications. Epidemiological knowledge is crucial in determining the needs and challenges of HCV microelimination in CEE countries. Without reliable epidemiological data, we will not be able to set further goals or identify missed opportunities in this area. The main barrier of HCV elimination is insufficient HCV screening. In people living with HIV population HCV screening is extremely important to achieve HCV microelimination. The aim of our study is to evaluate the status of HCV microelimination among people living with HIV in the countries of the Euroguidelines in Central and Eastern Europe (ECEE) Network Group.
Methods
The ECEE Network Group consists of experts in the field of infectious diseases from 26 countries in the region.[14] The Group was established in February 2016 to promote standards of care for HIV and viral hepatitis infections in the CEE region. The experts from the ECEE Network Group are also professionals actively involved in the care of infectious diseases. Between April 26th and June 23rd 2023 the group proceeded with an on-line survey consisting of 32 questions on the HCV status in people living with HIV (the questionnaire is in the supplementary materials). The ECEE Network Group members were asked to report aggregated data on people living with HIV from their treatment centers. Twelve HIV centers from 11 countries responded: Albania (Medical University of Tirana), Bosnia and Herzegovina (University Clinical Centre of the Republic of Srpska, Banja Luka), Croatia, (University Hospital for Infectious Diseases, Zagreb), Czech Republic (two centers - Hospital Na Bulovce, Prague (Czech Republic1) and Charles University and Military University Hospital Prague (Czech Republic 2)), Estonia (Tartu University Hospital), Greece (General Hospital Attikon, University of Athens), Hungary (National Institute of Hematology and Infectious Diseases, Budapest), North Macedonia (Clinic for Infectious Diseases and Febrile Conditions Skopje), Republic of Moldova (Department of Infectious Diseases, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chișinău), Serbia (University Clinical Center of Vojvodina, Novi Sad) and Ukraine (Clinic of the Gromashevsky Institute of Epidemiology and Infectious Diseases within National Academy of Medical Sciences of Ukraine, Kyiv). The questionnaire assessed the status of HCV microelimination in 2022. Data were collected regarding the following: number of people living with HIV in care; standards for HCV antibody testing; number of HCV antibody positives; number of HCV RNA positives; access to treatment with DAA and its efficacy measured by sustained virological response at week 12 post treatment (SVR12). Data on all people living with HIV were collected including those who entered HIV care in 2022.
Our main findings are reported by frequencies and percentages. We report aggregated data on people living with HIV, no individual data on people living with HIV were collected.
The study was approved by the Bioethical Committee of the Medical University of Warsaw (Nr AKBE/61/2023).
Results
The main characteristics of people living with HIV in care in different treatment centers across the ECEE network are presented in Table 1. The total number of patients reported in the study was 18262, the biggest center being Republic of Moldova with 4366 patients and the smallest Bosnia and Herzegovina with 100 patients. They were predominantly male, 72.8% on average. The highest percentage of female patients were reported from Moldova and Ukraine (45.9% and 41.6% respectively). Ukraine also stood out with high percentage (36.1%) of injection drug use (IDU) route of HIV acquisition. All patients analyzed in the study had performed HCV testing at least once, with the exception of Moldova and Croatia, where the numbers were 88.2% and 99% respectively. The seroprevalence of anti-HCV antibody was <5% in 5 centers (Albania, Croatia, Serbia, North Macedonia and Hungary), 30.2% in Estonia and 29% in Ukraine, Greece and Moldova had high seroprevalence as well 15.3% and 15.6% respectively (Figure 1). The prevalence of HCV viremia among HCV-antibody positive people living with HIV ranged from 0% to 38.2% with the exception of Greece, where the HCV-RNA positivity reached 85% (Table 2). The percentage of people living with HIV with spontaneous HCV clearance ranged between 0% and 36% (Table 2). Among people living with HIV who entered care in 2022 (a total of 1626 patients), nine out of 12 ECEE centers reported cases of HCV/HIV coinfection, with five centers indicating that at least 50% of these individuals were HCV-viremic. The highest percentage of HCV/HIV coinfection was found in Greece: 14 out of 89 (15.7%) patients were HCV-viremic. The data on the subpopulation of people living with HIV who entered in care in 2022 are reported in Table 3 and Table 4.
All centers reported some practices of repeated HCV antibody testing of persons considered at higher risk for HCV acquisition, with 7 centers performing repeated annual hepatitis C antibody testing for all patients in care (Table 5).
DAAs were introduced in 83% of HIV medical care centers in Central and Eastern European Countries. The firsts drugs were available in 2014 in Czech Republic. DAAs were introduced in the most of countries before 2019. They were still not available in 2022 in one country – Albania (Table 6).
Discussion
While a significant number of people living with HIV with HCV infection have been treated with DAAs, leading to progress in eliminating HCV among people living with HIV in many ECEE network treatment centers, our study highlights several persistent challenges. All centers in the network, except for Albania, reported that DAAs have been available for many years. However, HCV elimination among all individuals with HIV was only reported in centers with very small numbers of coinfected individuals, where the predominant mode of HIV acquisition is sex between men. In the majority of centers (8 out of 11), HCV-viremic people living with HIV remained in care. Notably, in the Greek treatment center, only 15% of individuals with HIV/HCV had an undetectable HCV viral load at their last measurement, underscoring the challenges in organizing care and treatment for people who inject drugs. In the majority of treatment centers (6 out of 11 that responded), the prevalence of HCV viremia among people living with HIV with HCV antibodies ranged from 4.2% to 38.2% (Table 2). By contrast, a cohort study from Australia demonstrated that an HCV microelimination program reduced the prevalence of HCV viremia among people living with HIV from 85% during the period 2014-2016 to 0.5% during 2020-2023.[15] Nine out of 12 ECEE centers reported enrolling individuals with HCV/HIV coinfection in 2022, with five centers indicating that at least 50% of these individuals were HCV-viremic upon entry into care. Centers in the Czech Republic, Hungary, and Croatia also reported a substantial number of people living with HIV with undetectable HCV viremia entering care, likely reflecting an influx of HCV treated Ukrainian war refugees.[16]
In our study, HCV screening in people living with HIV followed by access to DAA treatments were available in all but one center. It is reasonable to start the elimination of HCV infection by targeting specific subpopulations, like people living with HIV, who are at higher risk of acquiring HCV or developing HCV-related complications, instead of pursuing population-wide HCV elimination. Nationwide hepatitis elimination programmes could be extremely challenging for a lot of countries. This HCV microelimination goal is epidemiologically explainable due to the shared behavioral risk factors, such as sharing needles/syringes and diluent or unprotected sexual contacts.[17] DAA treatment is just as effective for persons with HIV/HCV co-infection as it is for people with HCV mono-infection, unlike the previous interferon-based treatment.[18] WHO and Centers for Disease Control and Prevention – Division of Viral Hepatitis 2025 Strategic Plan aims to significantly increase HCV cure due to the availability and efficacy of DAA treatment.[5] However, it is not possible in countries without DAA access. DAAs were approved for use in patients with HCV in late 2013 and early 2014.[19] This has dramatically changed the patients’ prospects for recovery from the disease and improvement of their quality of life without HCV-related complications due to the fact that cure rates were greater than 90% in the majority of patients.[20] However, as our study shows, not all Central and Eastern European countries have access to DAAs. In Western Europe Countries DAAs are available in every country.[21,22,23,24] In our region there is a need to demand equity in access to DAAs and immediate systemic solutions are needed to eliminate HCV globally. However, access to DAAs is not the only problem with HCV-microelimination. In the study Bartalucci et al.[3] defined the barriers to HCV-microelimination among PLWH. The most common barrier to treatment was poor adherence to therapies and follow-up visits, moreover recent HCV diagnosis awaiting proper staging (n=3, 16%) and treatment hesitancy. There are many additional barriers to microelimination, including healthcare access, the cost of DAAs, the existence and acceptability of harm reduction programs, reinfection risks, stigma, and, in general, the social determinants of health.
In our study there are some limitations which should be mentioned. Of the 26 countries invited to the study, we received data from twelve centers from eleven countries, which means that the epidemiological data are not complete for the entire region of Central and Eastern Europe. This also emphasizes the difficulties some treatment centers have in the EEEC network to readily generate data on HCV/HIV coinfected individuals. Moreover, the presence of missing data in several centers significantly impacts the ability to compare results across countries within the CEE region. This limitation also shows that there is a lack of systematic and mandatory epidemiological surveillance, which would facilitate the analysis of the epidemiological situation in the region.
Furthermore, this was an online survey based study in which we have preselected respondents based on our best knowledge of their expertise and up-to-date acquaintance with epidemiological and clinical data from the country. Because of the cross-sectional nature of the study, we cannot report on the change of the proportion of HCV viremic people living with HIV in care. The heterogeneity in health care systems, populations, and HCV prevalence rates among people living with HIV does not allow us to summarize the findings for the whole network. Nevertheless, we present data on HCV elimination among people living with HIV from 12 treatment centers across 11 countries in the ECEE network, data that is not readily available.
It should also be mentioned that given the potential differences in the emergence of DAA-resistant HCV strains circulating across CEE countries studied, strain sequencing should be emphasized as a key micro-elimination strategy. Strain sequencing is not only vital for identifying resistance patterns but also for tailoring more effective treatment plans. Furthermore, strain typing plays a critical role in determining whether an HCV case originates from imported strains or is linked to locally circulating strains. Incorporating strain sequencing and typing into national micro-elimination strategies can significantly improve targeted interventions and overall disease management effort. Such data were not available in CEE countries.
Conclusions
Microelimination of HCV in people living with HIV in the majority of surveyed HIV treatment centers in the ECEE network has not been achieved and efforts to reach this goal need to be strengthened. There is a critical need to standardize tools for collecting and organizing data related to HCV micro-elimination programs. This includes harmonizing methodologies for primary screening and tracking the utilization of DAA. Establishing standardized tools will enhance data comparability across regions, facilitate better monitoring of program outcomes, and support the development of more effective strategies to achieve HCV elimination goals.
Author Contributions
Study design AS-K and JB; data collection SeA, SvA, KP, AP, DM, BL, AV, MZ, ZB, MS, GD, AH, DJ, KA, LC; data analyses JB; data interpretation JK, AS-K and JB. Draft manuscript JB and AS-K. All authors have read and approved the final version of the manuscript.
Funding
None to declare.
Ethical Approval
The study was approved by the Bioethical Committee of the Medical University of Warsaw (Nr AKBE/61/2023).
Data Availability Statement
The datasets used and/or analyzed during the current study can be made available by the corresponding author upon reasonable request.
Conflicts of Interest
All authors – none to declare.
References
- Hollande, C.; Parlati, L.; Pol, S. Micro-elimination of hepatitis C virus. Liver Int. 2020, 40 (Suppl. 1), 67–71. [Google Scholar] [CrossRef]
- Chen, G.J.; Ho, S.Y.; Su, L.H.; et al. Hepatitis C microelimination among people living with HIV in Taiwan. Emerg Microbes Infect. 2022, 11, 1664–1671. [Google Scholar] [CrossRef] [PubMed]
- Bartalucci, C.; Taramasso, L.; Nicolini, L.A.; et al. Barriers to HCV micro-elimination in a cohort of people living with HIV (PLWH). New Microbiol. 2023, 46, 246–251. [Google Scholar] [PubMed]
- Danta, M.; Brown, D.; Bhagani, S.; et al. Recent epidemic of acute hepatitis C virus in HIV-positive men who have sex with men linked to high-risk sexual behaviours. AIDS. 2007, 21, 983–991. [Google Scholar] [CrossRef] [PubMed]
- Tetteh, R.A.; Nartey, E.T.; Lartey, M.; et al. Adverse events and adherence to HIV post-exposure prophylaxis: A cohort study at the Korle-Bu Teaching Hospital in Accra, Ghana. BMC Public Health. 2015, 15, 573. [Google Scholar] [CrossRef]
- Stöver, H.; Meroueh, F.; Marco, A.; et al. Offering HCV treatment to prisoners is an important opportunity: Key principles based on policy and practice assessment in Europe. BMC Public Health. 2019, 19, 30. [Google Scholar] [CrossRef]
- Thein, H.H.; Yi, Q.; Dore, G.J.; Krahn, M.D. Natural history of hepatitis C virus infection in HIV-infected individuals and the impact of HIV in the era of highly active antiretroviral therapy: A meta-analysis. AIDS. 2008, 22, 1979–1991. [Google Scholar] [CrossRef]
- Chew, K.W.; Bhattacharya, D. Virologic and immunologic aspects of HIV-hepatitis C virus coinfection. AIDS. 2016, 30, 2395–2404. [Google Scholar] [CrossRef]
- Kowalska, J.D.; Skrzat-Klapaczyńska, A.; Bursa, D.; et al. HIV care in times of the COVID-19 crisis - Where are we now in Central and Eastern Europe? Int J Infect Dis. 2020, 96, 311–314. [Google Scholar] [CrossRef]
- Blach, S.; Kondili, L.A.; Aghemo, A.; et al. Impact of COVID-19 on global HCV elimination efforts. J Hepatol. 2021, 74, 31–36. [Google Scholar] [CrossRef]
- Skrzat-Klapaczyńska, A.; Matłosz, B.; Otelea, D.; et al. Epidemiological characteristics and access to end-stage liver disease care for HIV-positive patients with HCV and/or HBV coinfections in Central/Eastern European and neighboring countries – data from the ECEE network. Przegl Epidemiol. 2019, 73, 61–68. [Google Scholar] [CrossRef] [PubMed]
- European Centre for Disease Prevention and Control/WHO Regional Office for Europe. HIV/AIDS surveillance in Europe 2017 – 2016 data; ECDC: Stockholm, 2017. [Google Scholar]
- Skrzat-Klapaczyńska, A.; Kowalska, J.D.; Afonina, L.; et al. The management of HIV care services in Central and Eastern Europe: Data from the Euroguidelines in Central and Eastern Europe Network Group. Int J Environ Res Public Health. 2022, 19, 7595. [Google Scholar] [CrossRef] [PubMed]
- The Euroguidelines in Central and Eastern Europe (ECEE) Network Group. Available online: https://www.eceenetwork.com (accessed on 24 April 2025).
- Martinello, M.; Carson, J.M.; Post, J.J.; et al. Control and elimination of hepatitis C virus among people with HIV in Australia: Extended follow-up of the CEASE cohort (2014-2023). Open Forum Infect Dis. 2024, 11, ofae665. [Google Scholar] [CrossRef] [PubMed]
- Kowalska, J.D.; Rukhadze, N.; Sojak, L.; et al. Preliminary report on the provision of HIV care to war refugees with HIV who are migrating from Ukraine: Data from the ECEE Network Group. AIDS. 2022, 36, 1887–1890. [Google Scholar] [CrossRef]
- Matthews, G.V.; Dore, G.J. HIV and hepatitis C coinfection. J Gastroenterol Hepatol. 2008, 23 Pt 1, 1000–1008. [Google Scholar] [CrossRef]
- Collins, L.F.; Chan, A.; Zheng, J.; et al. Direct-acting antivirals improve access to care and cure for patients with HIV and chronic HCV infection. Open Forum Infect Dis. 2017, 5, ofx264. [Google Scholar] [CrossRef]
- Do, A.; Mittal, Y.; Liapakis, A.; et al. Drug authorization for sofosbuvir/ledipasvir (Harvoni) for chronic HCV infection in a real-world cohort: A new barrier in the HCV care cascade. PLoS ONE. 2015, 10, e0135645. [Google Scholar] [CrossRef]
- Lim, J.K.; Liapakis, A.M.; Shiffman, M.L.; et al. Safety and effectiveness of ledipasvir and sofosbuvir, with or without ribavirin, in treatment-experienced patients with genotype 1 hepatitis C virus infection and cirrhosis. Clin Gastroenterol Hepatol. 2018, 16, 1811–1819.e4. [Google Scholar] [CrossRef]
- Busschots, D.; Kremer, C.; Koc, Ö.M.; et al. The hepatitis C cascade of care in the Belgian HIV population: One step closer to elimination. Int J Infect Dis. 2021, 105, 217–223. [Google Scholar] [CrossRef]
- Marshall, A.D.; Pawlotsky, J.M.; Lazarus, J.V.; Aghemo, A.; Dore, G.J.; Grebely, J. The removal of DAA restrictions in Europe - One step closer to eliminating HCV as a major public health threat. J Hepatol. 2018, 69, 1188–1196. [Google Scholar] [CrossRef]
- Pol, S.; Fouad, F.; Lemaitre, M.; et al. Impact of extending direct antiviral agents (DAA) availability in France: An observational cohort study (2015-2019) of data from French administrative healthcare databases (SNDS). Lancet Reg Health Eur. 2021, 13, 100281. [Google Scholar] [CrossRef]
- Politi, J.; Regidor, E.; Donat, M.; Pulido, J.; Guerras, J.M.; Barrio, G.; Belza, M.J. Free access to direct-acting antivirals in Spain: More favorable impact on hepatitis C mortality among highly educated people. Clin Infect Dis. 2023, 76, 1423–1430. [Google Scholar] [CrossRef]
Figure 1.
Seroprevalence of anti-HCV antibodies and prevalence of HCV viremia among people living with HIV at 12 medical centers from 11 countries of Central and Southeastern Europe in 2022. Treatment centers are listed in the methods section. * HCV viremia shown among individuals who tested positive for anti-HCV antibodies.
Figure 1.
Seroprevalence of anti-HCV antibodies and prevalence of HCV viremia among people living with HIV at 12 medical centers from 11 countries of Central and Southeastern Europe in 2022. Treatment centers are listed in the methods section. * HCV viremia shown among individuals who tested positive for anti-HCV antibodies.
Table 1.
The sex distribution and the routes of HIV acquisition in people living with HIV under care in 12 Central and Southeastern Europe medical centers in 2022.
Table 1.
The sex distribution and the routes of HIV acquisition in people living with HIV under care in 12 Central and Southeastern Europe medical centers in 2022.
| Country | Number in care | Males N (%) | Females N (%) | MSM N (%) | Heterosexual N (%) | IDU N (%) | Other/unknown N (%) |
|---|---|---|---|---|---|---|---|
| Czech Republic (1) | 2396 | 2036 (85) | 360 (15) | 1316 (54.9) | 820 (34.2) | 138 (5.8) | 0 (0) |
| Croatia | 1441 | 1288 (89.4) | 153 (10.6) | 1061 (73.6) | 280 (19.4) | 31 (2.2) | 69 (4.8) |
| Greece | 1265 | 1062 (84) | 203 (16) | 845 (66.8) | 250 (19.8) | 170 (13.4) | 0 (0) |
| Albania | 800 | 580 (72.5) | 220 (27.5) | 130 (16.3) | 650 (81.3) | 10 (1.3) | 0 (0) |
| Serbia | 450 | No data | No data | No data | No data | No data | No data |
| North Macedonia | 382 | 355 (92.9) | 27 (7.1) | 278 (72.8) | 95 (24.9) | 0 (0) | 9 (2.4) |
| Czech Republic (2) | 315 | 271 (86) | 44 (14) | No data | No data | No data | No data |
| Estonia | 252 | No data | No data | 36 (14.3) | 89 (35.3) | 7 (2.8) | 120 (47.6) |
| Bosnia and Herzegovina | 100 | No data (0) | No data (0) | No data (0) | No data (0) | No data (0) | No data (0) |
| Ukraine | 3095 | 1796 (58) | 1289 (41.6) | 99 (3.2) | 1869 (60.4) | 1117 (36.1) | 10 (0.3) |
| Hungary | 3400 | 2954 (86.9) | 446 (13.1) | 2600 (76.5) | 521 (15.3) | 20 (0.6) | 259 (7.6) |
| Republic of Moldova | 4366 | 2364 (54.1) | 2002 (45.9) | 181 (4.1) | 3671 (84.1) | 401 (9.2) | 113 (2.6) |
MSM – men who have sex with men; IDU – injection drug users.
Table 2.
The hepatitis C antibody status and hepatis C viral load status of people living with HIV in care in 12 Central and Southeastern Europe medical centers in 2022.
Table 2.
The hepatitis C antibody status and hepatis C viral load status of people living with HIV in care in 12 Central and Southeastern Europe medical centers in 2022.
| Country or center | People living with HIV | |||||||
|---|---|---|---|---|---|---|---|---|
| Total in care | HCV test (ever) | Positive HCV antibodies | Positive HCV viremiaa N (%) | Undetectable HCV RNAb | Spontaneous HCV clearance | SVR-12 achieved | On DDA treatmentc | |
| N (%) | N (%) | N (%) | N (%) | N (%) | N (%) | N (%) | N | |
| Czech Republic (1) | 3500d | 3500 (100) | 350 (10.0) | 50/350 (14.3) | 300/350 (85.7) | 100/300 (33.3) | 200 (66.6) | 0 |
| Croatia | 1441 | 1426 (99) | 67 (4.6) | 19/67 (28.4) | 48/67 (71.6) | 12/48 (25.0) | 36 (75.0) | 1 |
| Greece | 1265 | 1265 (100) | 193 (15.3) | 164/193 (85.0) | 29/193 (15.0) | 8/29 (27.6) | 21 (73.4) | 3 |
| Albania | 800 | 800 (100) | 20 (2.5) | 4/20 (20.0) | 16/20 (80.0) | No data | No data | 0 |
| Serbia | 450 | 450 (100) | 7 (1.6) | 0/7 (0) | 7/7 (100) | 0 | 7 (100) | No data |
| North Macedonia | 382 | 382 (100) | 4 (1.0) | 0/4 (0) | 4/4 (100) | 0 | 4 (100) | 0 |
| Czech Republic (2) | 315 | 315 (100) | 22 (7.0) | 0/22 (0) | 22/22 (100) | 8/22 (36.4) | 14 (64.6) | 0 |
| Estonia | 252 | 252 (100) | 76 (30.2) | 29/76 (38.2) | 47/76 (61.8) | 0 | 47 (100) | 8 |
| Bosnia and Herzegovina | 100 | 100 (100) | 10 (10.0) | 0/10 (0) | 10/10 (100.0) | 0 | 10 (100) | 2 |
| Ukraine | 3095 | 3095 (100) | 897 (29.0) | 66/897 (7.4) | 831/897 (92.6) | 67/831 (8.1) | 764 (91.9) | 0 |
| Hungary | 3400 | 3400 (100) | 120 (3.5) | 5/120 (4,2) | 115/120 (95,8) | 15/115 (13.0) | 100 (87.0) | 2 |
| Republic of Moldova | 4366 | 3851 (88.2) | 679 (15.6) | No data | No data | No data | No data | No data |
aBased on the answer about undetectable HCV RNA; bUndetectable HCV RNA at last measurement; cSVR-12 not yet reached; dEstimation for the whole country. HCV – hepatitis C virus; SVR-12 – sustained virologic response at posttreatment week 12; DAA – direct antiviral agents.
Table 3.
The sex distribution and the routes of HIV acquisition of people living with HIV who entered HIV care in 12 Central and Southeastern Europe medical centers in 2022.
Table 3.
The sex distribution and the routes of HIV acquisition of people living with HIV who entered HIV care in 12 Central and Southeastern Europe medical centers in 2022.
| Country of center | Number of patients entering care in 2022 - N | Males | Females | MSM | Heterosexual | IDU | Other/unknown |
|---|---|---|---|---|---|---|---|
| Czech Republic 1 | 175 | 142 (81.1) | 33 (18.9) | No data | No data | No data | No data |
| Croatia | 112 | 89 (79.5) | 23 (20.5) | 68 (60.7) | 25 (22.3) | 3 (2.7) | 16 (14.3) |
| Greece | 89 | No data | No data | No data | No data | 14 (15.7) | No data |
| Albania | 91 | 68 (74.7) | 23 (25.3) | 16 (17.6) | 72 (79.1) | 3 (3.3) | |
| Serbia | 60 | 60 (100) | 0 | 55 (91.7) | 4 (6.7) | 1 (1.7) | 0 |
| North Macedonia | 42 | 40 (95.2) | 2 (4.8) | 26 (61.9) | 11 (26.2) | 0 (0) | 5 (11.9) |
| Czech Republic 2 | 143 | 108 (75.5) | 35 (25.5) | Majority | No data | No data | No data |
| Estonia | 18 | 5 (27.8) | 13 (72.2) | 1 (5.6) | 12 (66.7) | 1 (5.6) | 5 (27.8) |
| Bosnia and Herzegovina | 26 | 21 (80.8) | 5 (19.2) | 20 (76.9) | 5 (19.2) | 1 (3.8) | 0 |
| Ukraine | 216 | 147 (68.1) | 69 (31.9) | 11 (5.1) | 154 (71.3) | 51 (23.6) | 0 |
| Hungary | 166 | 140 (84.3) | 26 (15.7) | 112 (67.5) | 43 (25.9) | 3 (1.8) | 8 (4.8) |
| Republic of Moldova | 488 | 286 (58.6) | 202 (41.4) | 21 (4.3) | 432 (88.5) | 26 (5.3) | 9 (1.8) |
MSM – men who have sex with men; IDU – injection drug users.
Table 4.
The hepatitis C antibody status and hepatitis C viral load status of people living with HIV who entered HIV care in 12 Central and Southeastern Europe medical centers in 2022.
Table 4.
The hepatitis C antibody status and hepatitis C viral load status of people living with HIV who entered HIV care in 12 Central and Southeastern Europe medical centers in 2022.
| Country of center | Number of PLWH entering care in 2022, N | Number of PLWH who ever had an HCV test, N (%) | Number of PLWH who are HCV positive, N (%) | Undetectable HCV-RNA, n/N (%) | Of those with an undetectable HCV viral load how many were previously treated for HCV and have had at least SVR12, N |
|---|---|---|---|---|---|
| Czech Republic 1 | 175 | 174 (99.6) | 12 (6.8) | 11/12 (90) | 10 |
| Croatia | 112 | 107 (95.5) | 12 (10.7) | 6/12 (50) | 6 |
| Greece | 89 | 89 (100) | 15 (16.9) | 1/15 (5.7) | 0 |
| Albania | 91 | 91 (100) | 0 (0) | 0 | 0 |
| Serbia | 60 | 60 (100) | 0 (0) | 0 | 0 |
| North Macedonia | 42 | 42 (100) | 0 (0) | 0 | 0 |
| Czech Republic 2 | 143 | 143 (100) | 9 (6.3) | 9/9 (100) | 4 |
| Estonia | 18 | 18 (100) | 5 (27.8) | 0 | 0 |
| Bosnia and Herzegovina | 26 | 26 (100) | 2 (7.7) | 1/2 (50) | 1 |
| Ukraine | 216 | 216 (100) | 32 (14.8) | 6/32 (18.8) | 2 |
| Hungary | 166 | 166 (100) | 12 (7.2) | 5/12 (41.7) | No data |
| Republic of Moldova | 488 | 405 (83) | 34 (7.0) | No data | No data |
PLWH – people living with HIV; HCV – hepatitis C virus; SVR12 – sustained virologic response at posttreatment week 12; DAA – direct antiviral agents.
Table 5.
Repeated annual hepatitis C antibody testing in 12 Central and Southeastern Europe medical centers in 2022.
Table 5.
Repeated annual hepatitis C antibody testing in 12 Central and Southeastern Europe medical centers in 2022.
| Country of center | All | MSM | IDU | Only those you consider a risk for HCV- infection: | Comment |
|---|---|---|---|---|---|
| Czech Republic 1 | Yes | Yes | Yes | Yes | All |
| Croatia | No | Yes | No | Yes | |
| Greece | No | No | No | Yes | In Greece people who inject drugs are always HCV positive. Therefore, we only test routinely MSM who are in high risk for new HCV infection (chemsex, groupsex, slamming) |
| Albania | No | No | No | Yes | PLWH with thalassemia |
| Serbia | Yes | Yes | Yes | Yes | |
| North Macedonia | No | No | Yes | Yes | If the patient reports risk behavior |
| Czech Republic 2 | Yes | Yes | Yes | Yes | PEP, PrEP |
| Estonia | Yes | Yes | Yes | No | |
| Bosnia and Herzegovina | Yes | Yes | Yes | Yes | |
| Ukraine | Yes | Yes | Yes | Yes | We test only those who were previously negative and those newly diagnosed with HIV/taken in care in our clinic |
| Hungary | No | No | No | No | We perform an HCV screening for every person in every 2nd year or sooner if high liver enzymes at routine check up |
| Republic of Moldova | Yes | Yes | Yes | No | Previous negative result |
MSM – men who have sex with men; IDU – injection drug users; PEP – postexposure prophylaxis; PrEP – preexposure prophylaxis
Table 6.
The access to direct-acting antiviral agents in 12 Central and Southeastern Europe medical centers in 2022.
Table 6.
The access to direct-acting antiviral agents in 12 Central and Southeastern Europe medical centers in 2022.
| Country of center | DAA introduced |
| Czech Republic 1 | 2017 |
| Croatia | April 2017 |
| Greece | June 2015 |
| Albania | No DAA |
| Serbia | Aug 2018 |
| North Macedonia | 2017 |
| Czech Republic 2 | 2014 |
| Estonia | 2016 |
| Bosnia and Herzegovina | Oct 2015 |
| Ukraine | June 2015 |
| Hungary | June 2018 |
| Republic of Moldova | Nov 2017 |
DAA – direct-acting antiviral agents.
© GERMS 2025.
Share and Cite
MDPI and ACS Style
Skrzat-Klapaczyńska, A.; Antoniak, S.; Antonyak, S.; Protopapas, K.; Papadopoulos, A.; Maric, D.; Lakatos, B.; Verhaz, A.; Zlamal, M.; Bartovska, Z.; et al. The Status of Hepatitis C Microelimination Among People Living with HIV in Central and Eastern Europe in 2022—Data from Euroguidelines in Central and Eastern Europe Network Group. GERMS 2025, 15, 144-156. https://doi.org/10.18683/germs.2025.1464
AMA Style
Skrzat-Klapaczyńska A, Antoniak S, Antonyak S, Protopapas K, Papadopoulos A, Maric D, Lakatos B, Verhaz A, Zlamal M, Bartovska Z, et al. The Status of Hepatitis C Microelimination Among People Living with HIV in Central and Eastern Europe in 2022—Data from Euroguidelines in Central and Eastern Europe Network Group. GERMS. 2025; 15(2):144-156. https://doi.org/10.18683/germs.2025.1464
Chicago/Turabian StyleSkrzat-Klapaczyńska, Agata, Sergii Antoniak, Svitlana Antonyak, Konstantinos Protopapas, Antonios Papadopoulos, Daniela Maric, Botond Lakatos, Antonija Verhaz, Milan Zlamal, Zofia Bartovska, and et al. 2025. "The Status of Hepatitis C Microelimination Among People Living with HIV in Central and Eastern Europe in 2022—Data from Euroguidelines in Central and Eastern Europe Network Group" GERMS 15, no. 2: 144-156. https://doi.org/10.18683/germs.2025.1464
APA StyleSkrzat-Klapaczyńska, A., Antoniak, S., Antonyak, S., Protopapas, K., Papadopoulos, A., Maric, D., Lakatos, B., Verhaz, A., Zlamal, M., Bartovska, Z., Stefanovikj, M., Dragovic, G., Harxhi, A., Jilich, D., Aimla, K., Cojuhari, L., Kowalska, J., & Begovac, J. (2025). The Status of Hepatitis C Microelimination Among People Living with HIV in Central and Eastern Europe in 2022—Data from Euroguidelines in Central and Eastern Europe Network Group. GERMS, 15(2), 144-156. https://doi.org/10.18683/germs.2025.1464
