HCV Infection Is Occurring among HIV Positive U.S. Men,
ACTG Analysis Shows
incidence of hepatitis
C virus (HCV) infection may be increasing
among HIV positive
men in the U.S., according to an analysis of participants
in several AIDS Clinical Trial Group (ACTG) studies
presented this past weekend at the 60th Annual
Meeting of the American Association for the Study
of Liver Diseases (AASLD)
in Boston. Only 25% reported injection drug use,
suggesting that non-parenteral routes (for example,
sexual transmission) play a significant role.
around 2002, clinicians in the U.K. began reporting outbreaks
of apparently sexually transmitted acute HCV infection among
men who have sex with men. Only a small percentage reported
a history of drug injection, and genotypic analyses showed
that case clusters reflected sexual networks. Though not
entirely consistent from study to study, identified risk
factors have included fisting, use of sex toys, group sex,
sex in public venues such as bathhouses, other sexually
transmitted infections, and use of non-injected recreational
outbreaks have since been reported in several large cities
in Europe, in Australia, and in a few cities in the United
States (e.g., New York City, San Francisco). The U.S. cases,
however, have yet to receive the same attention as the European
clusters, and the extent of the epidemic nationwide is not
shed further light on this issue, researchers from Brown
University and Harvard School of Public Health performed
an analysis of HCV incidence among men participating in
the ACTG Longitudinal Linked Randomized Trials (ALLRT) cohort,
a long-term follow-up study of HIV positive individuals
enrolled in selected ACTG clinical trials in the U.S.
total of 17 ACTG studies performed HCV antibody testing
from 1996 through 2002. Starting in 2002, HCV antibody screening
was done at entry into the ALLRT cohort. Beginning in 2006,
repeat testing was carried out every 96 weeks.
investigators identified 2365 HIV positive male participants
who had an initial negative HCV antibody test result. Within
this group, 1830 men who received at least 1 subsequent
HCV test were included in an analysis of seroconversion
rates, contributing more than 7000 total person-years.
this subgroup, the average age at the time of the first
HCV test was 42 years (range 17-79), and 52% were over age
40. A majority (57%) of the men were white, 22% were black,
and 18% were Hispanic. Almost all (94%) were on highly
active antiretroviral therapy (HAART).
control for increased surveillance and the fact that follow-up
testing intervals changed over the course of follow-up,
the date of HCV seroconversion was designated as being halfway
between the last negative antibody test and the first positive
test. Follow-up durations varied, but nearly half the participants
(47%) were followed for more than 4 years.
researchers evaluated associations between self-reported
injection drug use (IDU) -- 0.5% reported current use and
5.3% reported past use -- CD4 cell count, and HIV viral
load. However, data about sexual or other non-IDU risk factors
were not available.
HCV infection is occurring in a U.S. HIV positive male population
despite engagement in care with HAART, potentially through
non-parenteral means," the investigators concluded. "HCV
antibody development was not related to immune status, but
was associated with inadequate HIV suppression."
initially HCV negative men seroconverted during follow-up,
for an overall incidence of 0.51 per 100 person-years.
mean age at the time of HCV seroconversion was 46 years
(range 22-69), and 72% were over age 40.
drug use was a significant predictor of HCV seroconversion.
of men who became infected with HCV reported injection
drug use, compared with 5% of non-seroconverters (P
75% of HCV seroconverters had no history of drug injection.
incidence was 2.67 per 100 person-years among injection
drug users compared with 0.40 among non-IDUs.
seroconversion was associated with having HIV viral
load > 400 copies/mL (44% at the time of HCV positive
antibody test vs 21% at the time of last negative HCV
test; P < 0.001).
infection was not, however, linked to CD4 cell count.
Brown University, Providence, RI; Statistical & Data
Analysis Center, Harvard School of Public Health, Boston,
Holubar, LE Taylor, K Wu, and others. Hepatitis C virus
(HCV) antibody seroconversion in a U.S. HIV-infected male
clinical trials population. 60th Annual Meeting of the American
Association for the Study of Liver Diseases (AASLD 2009).
Boston. October 30-November 1, 2009. Abstract LB14