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.