Background:  Several pilot studies using different doses and durations of hepatitis C virus (HCV) treatment have reported  efficacy of HCV treatment in HIV⁺ patients with acute HCV infection. Our aim was to evaluate virological outcome in a large cohort of patients with acute HCV receiving specific anti-HCV therapy in HIV⁺ patients with acute HCV.

Methods:  Patients with acute HCV, defined as a positive HCV RNA or HCV antibody seroconversion within 12 months after a negative polymerase chain reaction (PCR) or a negative HCV-antibody test were included in a European multicenter observational cohort study. Efficacy analysis were performed on patients with a definitive virological outcome (sustained virological response or non response). Comparisons between groups were performed using Wilcoxon or Fisher’s exact tests.

Results:  A total of 150 HIV-infected men with acute HCV were enrolled between 2001 and 2006. Reason for HCV test was a rise in hepatic transaminases in 97 patients. The main identified risk factors were unprotected sexual intercourse in 138 patients and drug use in 8 patients. Concomitant syphilis was reported in 25 patients (16%). Median age was 38 years (IQR 34 to 43 years). HCV genotype 1 was predominant (90 patients, 60%). At time of acute HCV diagnosis, 109 (70%) patients were on HAART with HIV RNA <400 copies/mL in 80%, with a median CD4 cells count of 433/mm³ (IQR 350 to 614), median alanine aminotransferase (ALT) 330 U/L (IQR 153 to 769), and a median HCV RNA 6 log₁₀ copies/mL (IQR 5.2 to 6.3). Of the total, 111 patients started anti HCV treatment; 14 patients with pegylated interferon, and 97 with pegylated interferon + ribavirin. Treatment was started within 6 months in 90% (median 12 weeks; IQR 5 to 20). Median duration of treatment was 25 weeks (IQR 23 to 43). Among the 101 patients with complete follow-up, sustained virological response was obtained in 64% of patients (95%CI 54 to 74). There was no difference in sustained virological response by genotype; 63% in G1, and 67% in non-1 genotype (p = 0.83). Duration of treatment was similar between G1 and non-G1 (median 25 weeks for both groups, p = 0.82). There was no effect on sustained virological response rate of CD4 cells count, HIV viral load, HCV RNA, alanine aminotransferase (ALT), type of HAART at baseline, or treatment duration or HCV genotype.

Conclusions:  An overall high rate of sustained virological response was obtained in 64% of HIV-co-infected patients with acute HCV infection with early anti-HCV treatment using pegylated interferon alone or with ribavirin. This response was similar among patients infected by genotype 1 and non-1 genotype of HCV and largely due to early commencement of therapy.