7th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013)


TUAB0101 - Oral Abstract

HCV reinfection among HIV-positive men who have sex with men

Presented by Thomas Martin (United Kingdom).

T. Martin1, N. Martin2,3, M. Hickman2, P. Vickerman3, E. Page1, R. Everett1, B. Gazzard1, M. Nelson1

1Chelsea and Westminster Hospital, HIV Medicine, London, United Kingdom, 2Bristol University, School of Social and Community Medicine, Bristol, United Kingdom, 3London School of Hygiene and Tropical Medicine, Department of Global Health and Development, London, United Kingdom

Background: Liver disease caused by hepatitis C virus (HCV) infection in HIV-positive patients is one of the leading non-AIDS causes of death. Sexual transmission of HCV among HIV-positive men who have sex with men (MSM) may be fuelling the spread of HCV. HCV reinfection after successful treatment or spontaneous clearance may also be contributing to the increase in HCV incidence among HIV-positive MSM but the scale of reinfection is unknown. We calculated HCV reinfection rates among HIV-positive MSM after spontaneous clearance or successful treatment of HCV.
Methods: Retrospective analysis in a large London clinic of HIV-positive MSM with sexually acquired HCV who spontaneously cleared or underwent successful HCV treatment during 2004-2012. Patients were followed with regular HCV PCR, and person-time methods were used to calculate reinfection rates.
Results: Among 191 patients, 44 were reinfected over 562 person-years follow-up, yielding a reinfection rate of 7.8/100py (95%CI 5.8-10.5). Eight subsequent second reinfections occurred at a rate of 15.5/100py (95%CI 7.7-31.0). Combining all reinfections, 20% resulted in spontaneous clearance and sustained viral response rates following treatment were 73% (16/22) for genotype 1/4 and 100% (2/2) for genotype 2/3.
Comparisons following spontaneous clearance or successful treatment were restricted to the 145 patients with a negative HCV antibody within a year prior to their first infection. The reinfection rate among these patients was 8.0 per 100 person-years (95%CI 5.7-11.3) overall, 9.6/100py (95%CI 6.6-14.1) among those who were successfully treated and 4.2/100py (95%CI 1.7-10.0) among those who spontaneously cleared (p-value=0.15 for difference in reinfection rate following spontaneous clearance or successful treatment). 25% of patients were reinfected within 2 years following treatment.
Conclusion: HCV reinfection incidence is high among HIV-positive MSM emphasizing the need for regular follow-up including HCV PCR monitoring, increased sexual education and development of effective prevention interventions.
Our results suggest that patients may develop a degree of partial immunity following spontaneous clearance of HCV infection; however, further studies with greater power are needed to support this finding.

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