icon-folder.gif   Conference Reports for NATAP  
  53rd ICAAC Interscience Conference on
Antimicrobial Agents and Chemotherapy
September 10-13, 2013, Denver CO
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Acute C hepatitis in Japanese HIV-infected patients in this decade
  Reported by Jules Levin
ICAAC 2013 Sept 10-13 Denver. CO
Masahiro Ishikane1, Koji Watanabe1, Kunihisa Tsukada1, Hiroyuki Gatanaga1, Yoshimi Kikuchi1 and Shinichi Oka1
1AIDS Clinical Center(ACC), National Center for Global Health and Medicine (NCGM), Tokyo, Japan



An increasing number of acute C hepatitis (ACH) in HIV-infected men who have sex with men (MSM) has been reported from Western countries. However, reports from East Asian countries are limited.
A single-center retrospective cohort study was performed in our institution, the largest HIV clinic in Japan. ACH was defined as elevation of alanine transaminase (ALT) >100IU/L accompanied with seroconversion of anti-Hepatitis C virus (HCV) antibody. Incidence, symptoms and treatment outcome of ACH cases between 2001 and 2012 were reviewed with medical records. Data were expressed as median [range] unless otherwise notified.
Thirty four patients were diagnosed as ACH. The incidence of ACH was 2.1 cases per 1,000 person-years. The incidence was slightly higher in recent 5 years than previous 7 years (2.6 versus 1.5/1000 person-years, respectively). Age was 39 years [23-58]. Thirty three (97.1%) were male, including 32 MSM. Twenty eight (82.4%) received antiretroviral therapy at ACH diagnosis. CD4 count and HIV-RNA (copies/mL) were 366 [167-971] and undetectable (UD) [UD-94,000], respectively. Twenty eight (82.4%) were asymptomatic and diagnosed by chance at their routine visits. Although 5 patients had a history of injecting drug use, the route of HCV transmission was undetermined in all cases. The most frequent HCV genotype was 1b (67.9%). Spontaneous HCV clearance was achieved in 5 cases (CD4 count; 361/ul [184-971]). Treatment with Pegylated Interferon (Peg-IFN) plus Ribavirin (RBV) was initiated within 48 week in 12 patients. Interval between initial ALT elevation and initiation of IFN treatment was 4.0 months [0.9-6.9].Duration of Peg-IFN treatment was 45 weeks [11-72]. The rate of rapid viral response (RVR), early viral response (EVR) and sustained viral response (SVR) were 27.2%, 63.6% and 77.8%, respectively. Seventeen patients observed without IFN therapy progressed to chronic C hepatitis.
SVR rate was relatively high in our cases despite mostly HCV genotype 1b. Early treatment with Peg-IFN plus RBV should be considered for favourable response in HIV-infected patients with ACH.