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SPONTANEOUS CLEARANCE RATES INCREASE WITH HCV REINFECTION EPISODE IN
HIV-POSITIVE MEN WHO HAVE SEX WITH MEN (MSM) INDEPENDENT OF HCV SUBTYPE
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Reported by Jules Levin
EASL 2014
Patrick Ingiliz, Germany,
CROI/2015 [Andrew Hill]: Risk of late relapse or re-infection with Hepatitis C after Sustained Virological Response:
meta-analysis of 66 studies in 11,071 patients......http://www.natap.org/2015/CROI/croi_135.htm
Program abstract-
Background and aims: Most HCV patients
who will have access to new treatments will be cured in the future. In specific
subpopulations with ongoing risk behavior the epidemic may possibly be maintained.
The aim was to describe HCV reinfection in HIV infected MSM.
Methods: Retrospective
analysis of HCV reinfection cases from seven NEAT centers in Austria, Germany
and the United Kingdom. Reinfection was defined as a positive HCV RNA either
after sustained virological response (SVR) or spontaneous clearance (SC) or by
HCV geno-/subtype switch.
Results: Of 646 cured (SVR
and SC) cases with acute hepatitis C since 2002, 113 (17.5%) presented a median of 162 weeks later with a second
infection with a genotype switch in 55% of cases. All patients but one were MSM with a
median (IQR) age of 38 years (34-41). Most patients were HCV genotype 1 (71%)
or 4 (17%), 48.5% harboured the IL28B CC genotype.
Another median 122 weeks later, 19 patients presented with a third
episode (50% genotype switch), and three patients had a fourth episode 52 weeks
later. While 12.5% cleared the first episode spontaneously, this was the case
in 16.8% in the second and 47% in the third episode. In univariate analysis,
the only associated factor for clearance was clearance of a previous episode
(OR 4.6, 95%-CI: 1.3-15.9).
Conclusions: HCV reinfection is a significant problem in
HIV-positive MSM, and occurs independent of genotype switch. Spontaneous
clearance rates increase with episodes and previous clearers are more likely to
clear again.
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