In
recent years there have been reports of several outbreaks of apparently sexually
transmitted acute hepatitis C among mostly HIV positive men
who have sex with men (MSM) in European cities and Australia. These cases
are notable because the patients were known to already be infected with HIV
when they acquired HCV (typically, HCV is acquired first).
At the 2007 Conference on Retroviruses
and Opportunistic Infections (CROI) last February, Daniel Fierer and colleagues
from Mt. Sinai School of Medicine in New York City presented early data from a
prospective study of HIV positive MSM with acute HCV infection, defined as the
first 6 months after HCV infection. The researchers considered a combination of
3 criteria as indicators of acute hepatitis C: recent seroconversion to HCV antibody
positive status, marked elevations in serum alanine aminotransferase (ALT) level,
and wide fluctuations in HCV viral load.
Study participants underwent
liver biopsy within 4 months of the first-noted ALT elevation. Fibrosis was staged
using the Scheuer system, on a scale of 0 to 4. Fibrosis progression rate (FPR)
was calculated by dividing the fibrosis stage by the interval between the dates
of the recent ALT elevation and the biopsy.
As
previously reported, among the first 5 enrolled patients, 4 already had moderate
portal fibrosis during acute hepatitis C. At this year's CROI, taking place this
week in Boston, the researchers presented a poster describing further data from
more study participants.
Results
•
Of the 11 patients who underwent liver biopsy,
9 did so within 4.5 months of detection of ALT elevation, and 2 within 16 months.
•
Despite the short duration of HCV infection,
9 of the 11 (82%) had stage 2 fibrosis and 1 had stage 1 fibrosis.
•
The mean FPR in these 11 patients was 4.5
(± 3.3) units per year.
•
No causes of liver damage other than acute
HCV infection were identified.
•
In the analysis of risk factors for HCV acquisition,
only 4 patients reported even a single episode of intravenous drug use.
•
However, non-injection drug use and high-risk
sexual behavior were common.
•
7 reported club drug (including methamphetamine)
use and 10 reported unprotected anal intercourse with multiple partners.
Conclusion
Based
on these findings, the researchers concluded, "Acute HCV infection of MSM
with underlying HIV infection resulted in early and rapid progression of liver
fibrosis, with FPR rates far in excess of other settings of HCV infection."
"Many
of these HIV-infected men with acute HCV used non-injection drugs and had unprotected
sex with multiple partners," they continued. "Some appear to have become
HCV-infected via sexual activity."
The investigators recommended that,
"More intensive prevention and screening strategies for acute HCV in MSM
are needed," and "further research is needed to identify the disease
processes leading to this highly accelerated liver injury."
Mt
Sinai School of Medicine, New York, NY.
2/5/08
Reference D
Fierer, A Uriel, D Carriero, and others. An Emerging Syndrome of Rapid Liver Fibrosis
in HIV-infected Men with Acute HCV Infection. CROI 2008. Boston, MA. February
3-6, 2008. Abstract 1050.
Rapid
Liver Fibrosis Progression in HIV Positive Men with Acute HCV Infection
