Abstract PS9/1
 
Substantial Rates of Acute Hepatitis C Reinfection in European HIV-positive Patients Print
 
P. Ingiliz1, T.C. Martin2, C. Boesecke3, S. Mauss4, B.A. Payer5, M. Mandorfer5, A. Baumgarten1, H.-J. Stellbrink6, S. Bhagani7, J.K. Rockstroh3, M. Nelson2, and the NEAT Study Group
1Medical Center for Infectious Diseases, Berlin, Germany, 2Chelsea and Westminster Hospital, HIV Department, London, United Kingdom, 3University of Bonn, Medical Department, Bonn, Germany, 4Center for HIV and Hepatogastroenterology, Duesseldorf, Germany, 5Vienna Medical University, Vienna, Austria, 6ICH Study Center, Hamburg, Germany, 7Royal Free Hospital, London, United Kingdom
 
Objectives: Acute hepatitis C virus (AHC) infection in HIV infected men who have sex with men (MSM) is an ongoing threat in a high-risk population. As one fifth of patients experiences spontaneous clearance (SC) and others respond well to treatment, a substantial number of patients achieves viral eradication. With unchanged ongoing risk behaviour reinfection with hepatitis C (HCV) occurs.
Methods: 556 HIV-infected patients from 3 European countries (UK, Germany, Austria) were diagnosed with AHC and followed prospectively since 2002. Reinfection was defined as detectable HCV-RNA more than 24 weeks after sustained virological response (SVR) to treatment or after SC.
Results: Of 556 patients with AHC 395 (71%) cleared the first episode spontaneously or after treatment. Of these, 55 patients had a 2nd AHC infection (14%). All 55 patients were male, median age (range) was 38 years (34-41), main transmission risk was MSM (98.2%). Median CD4 cell count was 549/mm3 (409-740), and median HIV viral load was 50copies/ml (40-4.220). 70.4% of patients were on antiretroviral therapy. At second AHC, median peak ALT levels were 494U/L (275-1316), and median peak HCV viral load was 624.000IU/mL (120.000-2.300.000). Main HCV genotype (GT) was 1 (69.6%) followed by GT 3 and 4 (12.5% each). 46.4% of patients had an IL28B C/C genotype. 12.7% (n=7) of patients spontaneously cleared their second infection, the remaining 48 (87.3%) were treated with pegylated interferon and ribavirin. 83.6% of treated patients (n=46) achieved SVR. Of these, 4 patients (7.5%) had a 3rd AHC, one patient (1.9%) had a 4th infection.
Conclusions: Around 14% of HIV-positive patients eventually acquire a second HCV infection after clearance of a first AHC infection. This highlights the need for further research to identify factors associated with AHC transmission as well as the need for subsequent adequate counselling by the health care provider.


Assigned speakers:
Patrick Ingiliz , Germany

Assigned in sessions:
18.10.2013, 14:00-16:00, Parallel Session, PS9, HIV and Hepatitis Co-Infection, Bozar (Plenary Hall)