High rate of HCV reinfection after treatment of acute infection in Amsterdam gay men

Keith Alcorn
Published: 10 March 2011

Just over one-quarter of gay men with HIV successfully treated for acute hepatitis C infection became reinfected with hepatitis C within two years, almost all with a different genotype, Amsterdam doctors reported last week at the 18th Conference on Retroviruses and Opportunistic Infections (CROI 2011) in Boston.

The rate was ten times higher than the rate of acquisition seen among HIV-infected men infected for the first time, and suggests that health promotion activities with this group of men need to continue after treatment of acute infection, with greater exploration of a patient’s potential risk factors.

Sexually transmission of hepatitis C has been reported among gay and bisexual men in large urban communities in Europe, North America and Australia over the past decade, very predominantly among men who are HIV-positive.

Various explanations have been offered for the greater vulnerability of men with HIV infection, including serosorting and sexual networks in which men with HIV predominate, but sexual and drug-using practices are the fundamental determinant of who acquires hepatitis C infection.

Treatment of acute hepatitis C infection with pegylated interferon and ribavirin has been used as a means of preventing progression to chronic infection, which is harder to treat in HIV-positive people.

European guidelines on treatment of acute hepatitis C infection note that HIV-positive patients have a good response rate to treatment initiated within a year of infection.

Researchers from Amsterdam Academic Medical Center and the Amsterdam Public Health Service reported on cases of reinfection in HIV-positive men who had been successfully treated for a sexually transmitted hepatitis C infection. Successful response was defined as being HCV-negative by RNA testing at the end of the treatment period.

Twenty-eight patients were successfully treated. Two experienced hepatitis C relapse within two months of stopping treatment. Of the remaining 26 seven became reinfected with HCV within two years, an incidence of 19.6 per 100 person years of follow-up. The median time to reinfection was one year (range 0.2 – 1.6).

In each case a genotype change of some form occurred: three patients with previous genotype 4 infections acquired genotype 1, while two patients with genotype 1 acquired genotype 4. In a further case a genotype 1 reinfection occurred, but from a different clade.

The researchers say that discussion about prevention measures needs to take place not only at the time of diagnosis, but during and after treatment. In particular patients need to understand the range of possible transmission routes, and to feel able to have frank discussions with doctors about sexual practices, drug-using behaviour and ongoing risk factors.

Regular HCV testing in previously-treated individuals is also essential.

A German study showed a similar level of reinfection among HIV-positive men treated for acute HCV infection. 22% became reinfected within six years, despite declining incidence of first-time infection after 2008.

Reference

Lambers F et al. High incidence rate of HCV reinfection after treatment of acute HCV infection in HIV-infected MSM in Amsterdam. Eighteenth Conference on Retroviruses and Opportunistic Infections, Boston, abstract 958, 2011.

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