Alarming Incidence of Hepatitis C Virus Re-infection After Treatment of Sexually Acquired Acute Hepatitis C Virus Infection in HIV-infected MSM

Femke A.E. Lambers; Maria Prins; Xiomara Thomas; Richard Molenkamp; David Kwa; Kees Brinkman; Jan T.M. van der Meer; Janke Schinkel

Disclosures

AIDS. 2011;25(17):F21-F27. 

In This Article

Abstract and Introduction

Abstract

Background: Recent data indicate that seroprevalence of sexually transmitted hepatitis C virus (HCV) infection among MSM is stabilizing in Amsterdam. However, little is known about the incidence of HCV re-infection in MSM who have cleared their HCV infection. We, therefore, studied the incidence of re-infection in HIV-infected MSM who were HCV RNA-negative following HCV treatment of acute primary infection.
Methods: Our study population comprised HIV-infected MSM at two large HIV outpatient clinics in Amsterdam, who were previously diagnosed with a sexually transmitted acute HCV infection and tested HCV RNA-negative at the end of treatment. We defined HCV re-infection as detectable HCV RNA in individuals with an undetectable HCV RNA at the end of treatment accompanied by a switch in HCV genotype or clade. Person–time methods were used to calculate the incidence of re-infection.
Results: Fifty-six persons who became HCV RNA-negative during primary acute HCV treatment were included. Five of the 56 cases relapsed and were not analysed. Eleven persons were re-infected. The incidence of HCV re-infection in this group was 15.2 per 100 person-years (95% confidence interval 8.0–26.5). The cumulative incidence was 33% within 2 years.
Discussion: An alarmingly high incidence of HCV re-infection was found in this group. This high re-infection rate indicates that current prevention measures should be discussed, frequent HCV RNA testing should be continued after successful treatment and, in case of possible relapse, clade typing should be performed to exclude re-infection.

Introduction

In the last decade, the sudden increase in incidence of acute hepatitis C virus infection (HCV) among HIV-infected MSM in Europe, Australia and the United States has led to a substantial number of studies on this new public health problem. It has become clear that transmission takes place in specific clusters of HIV-infected MSM engaging in high-risk sexual behaviour.[1–3] Subsequently, targeted prevention messages have been developed, focusing on sexual risk behaviour, recreational drug use and regular testing for HCV. Furthermore, treatment of HCV co-infection in this population has proven to be very successful in the acute phase, and recommendations on treatment have been published.[4,5]

The response to this epidemic has clearly been extensive, and a recent study in Amsterdam has suggested that the prevalence of new primary HCV infections may no longer be increasing (A.T. Urbanus et al., presented at AIDS Conference 2010, abstract WEPDC 104). The question remains, however, whether prevention messaging and early testing and treatment also prevents HCV re-infection in MSM co-infected with HCV and HIV who have cleared their infection.

HCV re-infection occurs frequently among IDUs who continue high-risk behaviour.[6] Incidence rates of re-infection vary depending on population, definition of re-infection and methods and frequency of testing.[6–10] Reports on HCV re-infection by sexual transmission among MSM have been published only rarely[11,12] (H.-J. Stellbrink et al., presented at CROI 2011, poster 645; presented at International Congress on Drug Therapy in HIV Infection 2010, poster 200; and J. Sasadeusz et al., presented at EASL 2011, poster presentation), and no specific incidence rates have been presented yet.

Therefore, the objective of the current study was to examine the incidence of HCV re-infection among HIV-infected MSM attending two HIV outpatient clinics in Amsterdam, who were HCV RNA-negative at the end of treatment for their initial acute HCV infection.

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