Background:  Treatment of acute HCV with peg-interferon and ribavirin in the absence of HIV is effective, but data on treatment outcome of acute HCV in HIV-infected individuals are inconclusive. Therefore, we evaluated the efficacy of HCV treatment and the effect of treatment length on outcome among HIV-infected men who have sex with men (MSM) with acute HCV in Amsterdam.

Methods:  We retrospectively included all HIV-HCV co-infected MSM from 2 HIV outpatient clinics. Date of HCV infection was defined as the midpoint between the last HCV negative test (either HCV antibody or HCV PCR) and first positive test. For this analysis, we selected patients with an interval of <2 years between both tests and <2 years between estimated date of infection and start of treatment. Pearson Chi-square test and Mann-Whitney U test were used to test differences in age, HCV genotype (gt), CD4 count and ALAT level, time from HCV infection to HCV treatment, and HCV treatment length, between patients with and without sustained virological response 6 months post-treatment (SVR).

Results:  Fifty-three patients were included for this analysis; 34 with genotype 1; 1 with genotype 2; 1 with genotype 3; 11 with genotype 4, and 6 genotype unknown. Median age was 41 years (IQR 37 to 47). Median time from HCV infection to HCV treatment was 35 weeks (IQR 17 to 50). At HCV diagnosis, median CD4 count was 450 cell/mm³ and 98% had ALAT levels > 35 U/L. Forty-eight participants completed or ended treatment, of whom 27 (56%) started treatment with the intention to treat 24 weeks and 21 (44%) with the intention to treat 48 weeks. Forty-three (90%) were HCV RNA negative at end of treatment. Six months post-treatment time was reached by 40 patients, and in intention-to-treat-analysis SVR was seen in 27(68%). Overall, neither time to treatment, nor length of treatment was significantly associated with treatment outcome. In stratified analysis, when starting treatment within 6 months from infection, 82% had SVR in the 24 weeks treatment group and 75% in the 48 weeks treatment group (P >0.6). When starting treatment later this was 57% and 82% respectively (P >0.2).

Conclusions:  High SVR was observed in this group of HIV-infected MSM with acute HCV infection. No significantly better treatment outcome was observed with earlier or longer treatment. This suggests that 24 week treatment might be sufficient for acute HCV infection in HIV co-infected patients, especially when treatment is started within 6 months from infection.