Background:  Multiple outbreaks of acute hepatitis C virus (HCV) infection have recently been reported in HIV-infected men who have sex with men (MSM).  The extent of liver disease in these patients is unknown and is of concern.

Methods:  After providing informed consent, we enrolled in a prospective study of acute HCV infection, 4 consecutive HIV-infected MSM referred to Mount Sinai for the treatment of acute HCV infection.

Results:  All 4 patients had acute HCV infection confirmed using the following criteria (see the table):  alanine aminotransferase (ALT) elevations of >10 x ULN, HCV antibody seroconversion, and widely fluctuating HCV viral load; all had clinical and laboratory findings consistent with previously reported cases of acute HCV in HIV⁺ MSM.  Liver biopsy performed within 5 months of presentation with elevated ALT levels, surprisingly, showed moderate portal fibrosis (stage 2 of 4; Scheuer) in 3 of the 4 patients (1, 2, and 3), as well as the expected findings of acute viral hepatitis in all patients; moderate central hyalin sclerosis was found in patient 4. All patients had negative evaluations for hepatitis A virus (HAV) and hepatitis B virus (HBV); all denied heavy alcohol use; and 1 had never received ART. No cause of chronic liver disease common to all patients could be identified to explain the fibrosis.

Conclusions:  Of 4 consecutively evaluated HIV-infected MSM with acute HCV infection, 3 unexpectedly had moderately advanced portal fibrosis on liver biopsy; the fourth had central hyalin sclerosis. No other cause of liver injury was identified; therefore either fibrosis during acute HCV infection is greatly accelerated by pre-existing HIV infection, or chronic liver disease of unknown etiology predated the acute HCV infection in these men. These cases suggest that HIV-infected patients presenting with acute HCV infection may already have significant liver disease, and that liver biopsy should therefore be considered in these patients.

¹at presentation