HCV reinfection common in MSM with HIV

Ingiliz p, et al. J Hepatol. 2016;doi:10.1016/j.jhep.2016.09.004.

October 31, 2016

In a retrospective study, researchers found that hepatitis C virus reinfection is common among HIV-positive men who have sex with men after successful treatment and spontaneous clearance.

A subsequent high incidence of HCV reinfection has been reported regionally in men who both clear the infection spontaneously or who respond to treatment. … An accurate description of the HCV epidemic including a concise observation of reinfections in specific populations will be crucial to achieve the goal of HCV eradication and to reduce costs of repeated [direct-acting antiviral] treatment,” Patrick Ingiliz, MD, consultant at the Center for Infectiology, Berlin, Germany, and colleagues wrote.

Ingliz and colleagues evaluated the rate for HCV reinfections in MSM, also positive for HIV, from eight clinical centers in Europe enrolled in the NEAT network. Between 2012 and 2014, 606 men cleared HCV spontaneously (n = 111) or underwent successful treatment with pegylated interferon with or without ribavirin (n = 494). One patient had an undocumented cure.

Of all the patients, 24.6% presented with HCV reinfection (n = 149). In 142 cases of reinfection, alanine aminotransferase levels greater than 41 IU/mL were observed by the researchers.

Seventy patients had spontaneous clearance or documented cure of their first reinfection; however, 43% presented with a second reinfection (n = 30) at a median of 1.8 years after clearance of prior infection. In addition, five patients experienced a third reinfection and one experienced a fourth reinfection.

To calculate the incidence for HCV reinfection, researchers included 552 men with sufficient data. Of these, 143 cases of HCV reinfection occurred at 7.3 per 100 person-years (95% CI, 6.2-8.6). The median duration to reinfection was 2 years.

“This is the largest cohort of HIV-infected MSM patients follow-up longitudinally for HCV reinfections after initial HCV cure. … These numbers highlight the failure of current prevention strategies and the need for specific measures in the HIV-infected MSM population at risk in Europe,” the researchers wrote.

The researchers also found that men who had spontaneously cleared their incident infection had a lower incidence rate for reinfection (4.9 per 100 person-years) compared with men who were treated and then experienced reinfection (7.8 per 100 person-years; P = .06). Spontaneous clearance of reinfection was associated with ALT levels greater than 1,000 IU/mL and spontaneous clearance of a prior infection.

“Prevention strategies are needed for high-risk groups to reduce morbidity and treatment costs,” the researchers recommended. “HIV-positive MSM with a prior HCV infection should be tested every 3 to 6 months for reinfection, those who had achieved a reinfection every 3 months.” – by Melinda Stevens