SEATTLE – Men who have sex with men (MSM) with HIV who have successfully cleared co-infection with hepatitis C virus (HCV) often become re-infected with HCV, researchers reported here at the Conference on Retroviruses and Opportunistic Infections.
“Overall, what we found was that the re-infection rate was 4.4 per 100 patient years, which is a solid seven times that of the primary first infection rate for HIV-infected men who have sex with men,” said Daniel Fierer, MD, of the Icahn School of Medicine at Mount Sinai in New York City, at a press conference.
“Reinfections by themselves are not bad and should not be stigmatized,” he said. “It is really an important sign that you are treating the people who are actively transmitting disease.”
Reinfections in the U.S.-based study, he said, occurred at the same rate whether patients had cleared the infection spontaneously, through interferon-based therapy, or with newer direct-acting antivirals. Most re-infections occurred within the first 2 years, but infections continued to occur for more than 11 years after clearance.
“These data suggest that long-term surveillance is warranted for all HIV-infected men who have sex with men after clearance of hepatitis C virus infection,” Fierer said. “Further, strategies to reduce hepatitis C virus re-infections are needed to meet the goal of eliminating hepatitis C virus in these men who are at significant risk for hepatitis C virus infection.”
Press conference moderator Robert Schooley, MD, of the University of California, San Diego, commented that the study shows successful treatment of HCV among HIV-infected MSM is often not the end of the story. Many of these patients continue to engage in risky behaviors that lead to HCV re-infection.
“[Fierer’s] point was this population isn’t one that should be treated the British way – to say you have had your round of hepatitis C virus therapy, now be done with you – but rather the group you bring in and treat intensively every time they get infected because that is where the epidemic is being driven,” Schooley said.
“At the same time you bring them in, you can try to address issues related to prevention, but to say that you have had your course of treatment and we are not going to treat you again is a great way to accelerate the epidemic,” he said.
The investigators identified 267 HIV-infected MSM in New York City who had documented clearance of primary hepatitis C virus infection and for whom they had records with at least 4 weeks follow-up. HCV clearance was defined as sustained virologic response at 12 weeks by treatment of an undetectable viral load for at least 12 weeks if clearance was spontaneous. Re-infection was defined as new hepatitis C viremia after clearance.
Median age of men included in the study was 45; 64% were white, 15% were black, 21% were Hispanic. HCV genotypes were predominantly 1a – 80% of the 258 individuals for whom genotyping information was available. Median CD4 count among these HIV-infected individuals was 579 cells/μL; median HIV viral load was less than 50 copies/mL, indicating that most of the individuals had control of their HIV.
Thirty-eight men with re-infections were identified during the study period (2006-2018) with a total of 44 re-infections. These occurred a median of 1.5 years after clearance of hepatitis C virus. Time to re-infection did not differ according to how the men cleared the virus originally, Fierer reported.
That re-infections developed in 14% of the cohort is in line with data from Europe, where studies have found re-infection rates of 3% to 15%, he noted.
Fierer disclosed no relevant relationships with industry.
Schooley disclosed relevant relationships with Gilead Sciences.