Acute hepatitis C infection among adults with HIV in the Netherlands: a capture-recapture analysis

Background: Reliable surveillance systems are essential to assess the national response to eliminating hepatitis C virus (HCV), in the context of the global strategy towards eliminating viral hepatitis. Aim: We aimed to assess the completeness of the two national registries of acute HCV infection in people with HIV, and estimated the number of acute HCV infections among adults with HIV in the Netherlands. Methods: For 2003-2016, cases of HCV infection and reinfection among adults with a positive or unknown HIV-serostatus were identified in two national registries: the ATHENA cohort, and the National Registry for Notifiable Diseases. For 2013-2016, cases were linked, and two-way capture-recapture analysis was carried out. Results: During 2013-2016, there were an estimated 282 (95%CI: 264-301) acute HCV infections among adults with HIV. The addition of cases with an unknown HIV-serostatus increased the matches (from N=104 to N=129), and a subsequently increased the estimated total: 330 (95%CI: 309-351). Underreporting was estimated at 14-20%. Conclusion: In 2013-2016, up to 330 cases of acute HCV infection were estimated to have occurred among adults with HIV. National surveillance of acute HCV can be improved by increased notification of infections. Surveillance data should ideally include both acute and chronic HCV infections, and be able to distinguish between acute and chronic infections, and initial and reinfections.