Testing Still Needed After HCV Clears in HIV-Positive MSM

A study, recently published in the Journal of Hepatology analyzed rates of reinfection with hepatitis C in men who have sex with men (MSM) who are coinfected with HIV. The researchers studied data collected from eight centers from across Europe, and determined that there is a need for frequent testing among this population after HCV infection has been cleared.

According to the Centers for Disease Control and Prevention (CDC), approximately one-third of patients who have HIV are coinfected with either HCV or hepatitis B (HBV), with the majority having HCV (25%) rather than HBV (10%). This is problematic since hepatitis is more likely to cause liver complications in patients infected with HIV. Furthermore, the CDC notes that liver disease “has become the leading cause of non-AIDS-related deaths” in patients who are coinfected with hepatitis B or C and HIV. The CDC recommends “anyone living with HIV should be tested for HBV and HCV... [since] coinfection with hepatitis may also complicate the management of HIV infection.”

Moderate cure rates of acute HCV have been reported in the last decade among MSM who are also infected with HIV. However, many who either clear the infection spontaneously or through treatment are later reinfected, researchers noted.

“With a high treatment uptake in this population even in the interferon era and with higher response rates to treatment in the acute phase of infection, reinfections are most likely occurring due to maintained risk behaviors,” the study authors wrote in the study.

Chronic HCV infection can lead to cirrhosis and other serious liver damage, including liver cancer. The authors pointed out that for patients with HIV, liver disease is a major cause of morbidity and mortality.

The research team examined more than a decade of data on patients who documented as having been cured of acute HCV between 2002 and 2014. This included data from 8 centers in Austria, France, Germany, and the UK, which are part of the NEAT consortium (European AIDS Treatment Network).

Information gathered for the analysis included age, genotype, diagnosis date, as well as the date of cure and whether it was from treatment or spontaneous clearance of HCV, and the date of last follow-up visit.

Among the 606 patients, 494 men (81.5%) had achieved sustained virologic response—indicating a cure—after being treated for the virus with pegylated interferon and ribavirin; in addition, 111 men (18.3%) cleared the virus spontaneously.

Documentation and details were lacking for the remaining patient. Results showed that 149 of 606 men (24.6%) later presented with subsequent HCV infection. In some cases, patients became reinfected for a second, third, or fourth time.

“Thirty out of 70 (43%) who cleared again or were successfully treated, presented with a second reinfection, 5 with a third, and 1 with a fourth reinfection,” wrote lead author, Patrick Ingiliz, MD, of the Center for Infectiology in Berlin, Germany, and colleagues. “The reinfection incidence was 7.3/100 person-years (95% CI 6.2—8.6).”

The authors found the incidence of reinfection “alarming” and noted that the study findings underline a need for intervention during follow-up care after a patient is cured of HCV. They recommended prevention strategies such as testing for reinfection of HCV every 3 to 6 months among this high-risk group.

“Prevention strategies — both treatment and behavioral – are needed to target high risk groups to reduce morbidity and treatment costs,” the team concluded. “Patients as well as clinicians have to be aware of the specific risk behavior in this setting and counseling should be accompanied by behavioral interventions to avoid reinfections.”