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Session 31 Oral Abstracts
Hepatitis Virus Co-Infection
Thursday, 4 - 6 pm
Presentation Time: 5:00 pm
Auditorium


122
Homosexually Transmitted HCV Acute Infection Related to a Clustered Genotype 4 HCV in HIV-1-infected Men and Inefficacy of Early Antiviral Therapy
Marie-Laure Chaix*1, J Serpaggi2, D Batisse3, C Dupont4, A Vallet-Pichard2, H Fontaine2, J P Viard5, C Piketty3, E Rouveix4, C Rouzioux1, L Weiss3, and S Pol2
1Univ Rene Descartes, Ctr Hosp Univ Necker, Paris, France; 2INSERM U370, Ctr Hosp Univ Necker, Paris, France; 3Ctr Hosp Univ Georges Pompidou, Paris, France; 4Ctr Hosp Univ Ambroise Paré, Boulogne, France; and 5Ctr Hosp Univ Necker, Paris, France

Background:  HCV sexual transmission remains controversial. Recent studies suggest an increase of acute hepatitis C infections in homosexual HIV-infected men. While early treatment of acute hepatitis C with interferon significantly reduces the risk of chronic evolution in immunocompetent patients, efficacy of such a treatment is not known in HIV-infected patients. Here, we report 12 cases of sexually transmitted hepatitis C in HIV-1-infected men.

Methods:  Analysis of 12 HIV-1-infected patients who were diagnosed with acute hepatitis C, defined by both seroconversion of anti-HCV antibodies and detection of serum HCV RNA in previously anti-HCV and HCV RNA-negative patients. Genotyping of HCV isolates were performed using the HCV genotype assay (INOLIPA). For 10 cases, the non-structural 5B gene was amplified and sequenced for phylogenetic analysis. Of the 12 patients, 10 received early ART with standard interferon or pegylated interferon alone or in combination with ribavirin.

Results:  Homosexual exposure was the only significant risk factor reported in this population. Acute hepatitis C was symptomatic in only 2 patients. For the remaining patients, diagnosis of acute HCV hepatitis was done on systematic screening. INNOLIPA HCV genotypes were type 4 in 10 patients, type 1 in 1 patient, and type 3 in 1 patient. Phylogenetic analysis revealed that all 10 genotype 4 viruses were from subtype 4d. The 10 genotype 4d viruses formed a monophylogenetic group and clustered separately from other local sequences of HCV genotype 4d with a boostrap value of 90%, suggesting a common source of infection. None of the 10 patients treated with early antiviral therapy had a sustained virologic response as defined by undetectable HCV RNA 6 months after therapy.

Conclusions:  These results demonstrate a risk of sexual transmission of HCV in HIV-infected men who have sex with men; a cluster of HCV genotype 4d suggesting a common source of infection and the breakthrough of preventing counseling; and an inefficacy of early treatment with standard interferon of acute hepatitis C in HIV-infected patients to prevent chronic evolution of hepatitis C.

 

Keywords: acute HCV infection; sexual transmission; phylogenetic cluster