Hepatitis C still increasing in German gay men with HIV, reinfection common

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Almost half of Hamburg cohort who clear HCV likely to be reinfected within six years, researchers project

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.

Glossary

reinfection

In HIV, synonym for superinfection. In hepatitis C, used when someone who has been cured of the virus is infected with hepatitis C again.

acute infection

The very first few weeks of infection, until the body has created antibodies against the infection. During acute HIV infection, HIV is highly infectious because the virus is multiplying at a very rapid rate. The symptoms of acute HIV infection can include fever, rash, chills, headache, fatigue, nausea, diarrhoea, sore throat, night sweats, appetite loss, mouth ulcers, swollen lymph nodes, muscle and joint aches – all of them symptoms of an acute inflammation (immune reaction).

sustained virological response (SVR)

The continued, long-term suppression of a virus as a result of treatment. In hepatitis C, refers to undetectable hepatitis C RNA after treatment has come to an end. Usually SVR refers to RNA remaining undetectable for 12 or 24 weeks after ending treatment and is considered to be a cure (SVR12 or SVR24).

cure

To eliminate a disease or a condition in an individual, or to fully restore health. A cure for HIV infection is one of the ultimate long-term goals of research today. It refers to a strategy or strategies that would eliminate HIV from a person’s body, or permanently control the virus and render it unable to cause disease. A ‘sterilising’ cure would completely eliminate the virus. A ‘functional’ cure would suppress HIV viral load, keeping it below the level of detection without the use of ART. The virus would not be eliminated from the body but would be effectively controlled and prevented from causing any illness. 

equivalence trial

A clinical trial which aims to demonstrate that a new treatment is no better or worse than an existing treatment. While the two drugs may have similar results in terms of virological response, the new drug may have fewer side-effects, be cheaper or have other advantages. 

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.