EACS 2013: HCV Reinfection Common Among HIV Positive Gay Men in Europe

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A study found that 18% of HIV positive men acquired hepatitis C virus (HCV) a second time after clearing the virus, with some having third and fourth infections as well, according to findings from the European AIDS Treatment Network presented at the 14th European AIDS Conference this month in Brussels.

Since around 2000 researchers have been reporting outbreaks of apparently sexually transmitted acute hepatitis C among HIV positive men who have sex with men in major cities, first in the U.K. and continental Europe, followed by Australia and the U.S. Factors associated with HCV transmission -- which differ across studies -- include anal intercourse, fisting, group sex, other sexually transmitted infections, and use of non-injected recreational drugs.

Up to one-quarter of people with acute HCV infection clear the virus without treatment, while the remainder develop chronic hepatitis C lasting more than 6 months; spontaneous clearance is less common (around 15%-20%) among people with HIV. Treatment with interferon-based therapy is highly effective during acute infection. However, people who clear HCV naturally or with treatment remain susceptible to reinfection.

Patrick Ingiliz from the Medical Center for Infectious Diseases and fellow investigators with the NEAT Study Group looked at rates of HCV reinfection among HIV positive people in the U.K., Austria, and Germany.

The analysis included 646 men with HIV seen at 6 NEAT centers since 2002 who had acute hepatitis C with either spontaneous clearance (12%) or treatment-induced cure (88%). Men with a second or subsequent HCV infection were included in the analysis. Reinfection was defined as detectable HCV RNA after confirmed spontaneous clearance (negative HCV RNA at 24 weeks after diagnosis) or more than 24 weeks after sustained virological response (SVR) to treatment, or infection with a different genotype or clade than the initial infection.

Most people who did not spontaneously clear their subsequent HCV infection underwent treatment with pegylated interferon plus ribavirin; 2 also received telaprevir (Incivek) and 1 also received simeprevir (an experimental HCV protease inhibitor).

Results

"We confirm high HCV reinfection rates in HIV positive men who have sex with men with one cured episode of HCV," the researchers concluded. "Spontaneous clearance rates seem to increases with reinfection episodes. Spontaneous clearance of a previous episode increases the likelihood to clear again."

"We observed reinfections with the same or with a distinct HCV genotype, and did not find any evidence of immune protection when reinfected with the same genotype," they added.

"Understanding of risk behaviors and promoting strategies for risk-avoidance will be important to prevent reinfections in this population," they recommended.

10/25/13

Reference

P Ingiliz, TC Martin, C Boesecke, et al (NEAT Study Group). Substantial Rates of Acute Hepatitis C Reinfection in European HIV-positive Patients. 14th European AIDS Conference (EACS 2013). Brussels. October 16-19, 2013. Abstract PS9/1.