A survey from the main HIV clinic in Hamburg, Germany, presented at the Tenth Congress on Drug Therapy in HIV Infection in Glasgow, has found that the incidence of new hepatitis C infections in HIV-positive gay men is continuing to increase.
The survey also found that reinfection is common, with 22% of those who achieved clearance of hepatitis C (either spontaneously or after treatment) becoming reinfected within less than six years.
Taking the increasing frequency of infection into account, the investigators predict that 45% of those who have the equivalent of a cure for hepatitis C will have become infected again within the next six years.
The authors say their study underlines the need for routine hepatitis C testing in HIV-positive gay men, and they urge “intensive and repeated counselling” of gay men with HIV at risk of hepatitis C in order to reduce transmission risks.
The investigators looked at all 4851 gay male patients seen at the clinic between January 2002 and June 2010 and found 99 cases of acute hepatitis C infection in 88 HIV-positive patients, and only three in HIV-negative patients.
Of the 88 patients 70% were taking antiretroviral therapy at the time of hepatitis C diagnosis and 57% had an HIV viral load under 50 copies/ml. The average CD4 count at hepatitis C diagnosis was 526 cells/mm3.
Incidence increased exponentially between 2002 and 2007; nine cases were seen in the first two years, 13 in the next two and 25 in 2006-7. After this, incidence has continued to increase more slowly, with 32 new cases in 2008-9 and nine in the first half of 2010.
This pattern is different from that seen in a study from Amsterdam presented at the Vienna International AIDS Conference, which found acute hepatitis C cases drying up after January 2008, though hepatitis C prevalence in HIV-positive men remained high, at 15%.
Of the Hamburg patients, 61 were followed up for at least six months after their diagnosis or after they finished hepatitis C treatment. Of these, 13 (21%) spontaneously cleared their hepatitis C infection, and 32 (52%) achieved a sustained viral response (SVR) after treatment with pegylated interferon and ribavirin. Thus a quarter of patients were left chronically infected but 45 individuals achieved, essentially, a cure.
Over the next six years ten of these 45 patients were reinfected, six of them after treatment and four after spontaneous clearance. Some of the ten had more than one reinfection; one patient spontaneously cleared two infections with hepatitis C genotype 1 and one with genotype 3.
The poster documenting this study received the prize for best poster at the Glasgow Conference. Conference Chair Ian Weller commented that hepatitis C infection in HIV-positive gay men was a "public health disaster".
Reference
Stellbrink H-J et al. Increasing numbers of acute hepatitis C infections in HIV-infected MSM and high reinfection rates following SVR. Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, abstract P200, 2010.
