High rates of sexually transmitted HCV re-infection in HIV positive men who have sex with men: prevention is the key: 46th Annual Meeting of the European-Association-for-the-Study-of-the-Liver (EASL)

Background and Aims:
HCV is sexually transmitted among HIV-infected men who have sex with men (MSM). Treatment of acute HCV in coinfected individuals results in high sustained virological response (SVR) rates. Treatment of acute infection results in high sustained virological response (SVR) rates but little is known about long-term outcomes, especially the risk of reinfection (RI). We describe outcomes including HCV re-infection rates in a cohortof HIV individuals acutely infected with HCV.
Methods:
Cases of acute HCV from March 2003 to December2007 were identified from a clinic database. Case notes were reviewed to collect data on spontaneous HCV clearance (SC, defined as 2 consecutive negative HCV RNA at least 3 months apart), treatment responses and reinfection rates. RI was defined as HCV RNA detection following treatment-induced SVR or following2 consecutive undetectable RNAs at least 3 months apart following SC
Results:
Sixty-one individuals fulfilled the case definition for acute HCV; 72.7% were genotype 1 and 20% Genotype 4, all were male, and 96.7% (n = 59) had MSM as their risk factor for HIV infection (nil IDU). Nine (14.7%) had SC and 40 were treated with Pegylated interferon and weight-based Ribivirin of which 32/40(80%) achieved SVR. Of the 41 who achieved SC or SVR, 16 (39.0%) subsequently were HCV RI (one individual had 2 RIs) a median of 46 months (range 20–66mths) post initial HCV infection and all had MSM as their HIV risk factor. Peak ALT was lower at HCV re-infection than at initial HCV infection (mean diff 451 U/l, 95% CI35–867, p = 0.02) but there was no significant difference in mean HCV levels at baseline and re-infection. Only one RI had SC and nine underwent treatment of which 3 (33%) achieved SVR
Conclusion:
HCV infection remains high in HIV positive MSM individuals. There is no immunity conferred by prior infection. Wefound a very high rate of re-infection (over one third) in patients who either achieved SVR through treatment or cleared previous infections. There is a need to alter high-risk behaviours leading to re-infection and these findings highlight the issue of offering repeated HCV therapy for ultiple reinfections.