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Increase in HCV Incidence in HIV-1-infected Women and Men Followed in the French PRIMO Cohort
J Ghosn1, C Goujard2, C Deveau3, J Galimand1, I Garrigue4, N Saïchi3, C Delaugerre1, L Meyer3, C Rouzioux1, Marie-Laure Chaix*1, and PRIMO Cohort Study Group (ANRS CO 06)
1Univ Hosp Necker, Paris, France; 2INSERM E109, Univ Hosp Bicêtre, Le Kremlin-Bicêtre, France; 3INSERM U569, Univ Hosp Bicêtre, Le Kremlin-Bicêtre, France; and 4CHU Pellegrin, Bordeaux, France
Background: An increase in sexually transmitted
infections, and in the incidence of sexually transmitted hepatitis C infections
(HCV) in HIV-infected men who have sex with men have recently been reported.
Our objective was to
investigate HCV incidence among HIV-1-infected patients, identified at the time
of primary HIV infection and enrolled in the French PRIMO Cohort between 1996
and 2005.
Methods: We included patients with a minimum follow-up
of 18 months for this study. HCV antibody tests were done at inclusion and on
the latest available sample.
Results: To date, 605 patients had been included in the
French Primo Cohort, 27 of 605 (4.46%) had positive HCV antibodies at
inclusion. Of 605 patients, 402 had at least an 18-month follow-up and were
eligible for the present analysis. At inclusion, HCV antibodies were detected
in 23 of the 402 patients (4 of 75 women [5.33%] and 19 of 327 men [5.80%]). For
these 402 patients, median follow-up was 48 months (range 18 to 104), providing
a follow-up period of 1404 person-years. HCV seroconversion was observed in 5
patients (3 men and 2 women) corresponding to an HCV incidence rate of 3.56 per
1000 person-years. Incidence rate for men and for women was 2.61 and 7.81 per
1000 person-years, repectively. The incidence rate before January 2002 was 1.81
per 1000 person-years (n = 1 of 5
patients) and 4.69 per 1000 person-years (n
= 4 of 5 patients) after January 2002 (p = 0.24). In all 5 patients,
classical risk factors for HCV infection (injection drug users, blood transfusion,
recent invasive medical procedures surrounding seroconversion period) were
inquired into and not found. The only identified risk factor for HCV
acquisition was unsafe sex. One woman reported inconstant condom use, 2 men had
concomitant syphilis at the time of acute HCV, and the remaining man reported
at-risk sexual behaviour.
Conclusions: The
increase in the incidence of acute HCV infection in recently HIV-infected
patients confirms the shift in sexual behavior in the recent years. We report a
high HCV incidence among HIV-infected women, suggesting that women are also
at-risk of acquiring HCV via the sexual route. Repeated testing for HCV
antibodies should be done in HCV-negative HIV-infected patients and specific
recommendations concerning protected sex clearly provided for men and women
living with HIV.
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