Paper # 958|
High Incidence Rate of HCV Reinfection after Treatment of Acute HCV Infection in HIV+ MSM: Amsterdam
Femke Lambers*1, M Prins1,2, X Thomas2, R Molenkamp2, J van der Meer2, and J Schinkel2
1Publ Hlth Svc, Amsterdam, The Netherlands and 2Academic Med Ctr, Amsterdam, The Netherlands
Background: Recent data indicate that the prevalence of primary sexually
transmitted hepatitis C virus (HCV) infection is stabilizing at 15% among HIV+
men who have sex with men (MSM) visiting our sexually transmitted infections (STI)
clinic. This may suggest that incidence of primary infection is decreasing.
However, little is known about the incidence of HCV reinfection in previously infected
MSM. Our objective was to study the incidence rate of reinfection in HIV+
MSM who were HCV RNA at end of primary HCV treatment.
study population comprised HIV+ MSM previously diagnosed with a
sexually transmitted acute HCV infection at a HIV-outpatient clinic in Amsterdam, who were HCV RNA at end of treatment. Since most relapses occur
within 2 months after treatment, we defined HCV reinfection as having an HCV
RNA+ test result after having had a negative result at least 2
months after the end of treatment, and showing an HCV geno- or strain-type
switch. Backward HCV RNA testing on samples was performed to precisely
estimate reinfection date. Person-years at risk were calculated from the date
of the HCV sample 2 months after the end of treatment until the
date of first reinfection (midpoint between last negative and first positive
sample) or last negative sample.
primary acute HCV treatment, 28 persons became HCV RNA and remained
so until at last 2 months after the end of treatment. Within 2 months of
treatment end, 2 of the 28 relapsed and were omitted from analysis. According
to our definition, 6 persons had a reinfection: 1 person became positive 4
months after start follow-up, but his genotype was unknown and we therefore
excluded him from analysis. Total follow-up time of the 25 persons was 35.5
years; median follow-up 1.1 years (IQR 0.4 to 1.9). Median time between test
intervals was 2.9 months (IQR 1.6 to 4.1). The incidence of HCV reinfection in
this group was 16.9 /100 person-years (95%CI 6.9 to 35.2).
Conclusions: Despite high clearance rates and a possible decrease in incidence of
primary HCV infection among HIV+ MSM in Amsterdam, an alarmingly
high incidence of HCV reinfection was found in this group. The rate was about 10
times the HCV incidence described in HIV+ men without a history of
HCV infection and should be further studied. This high reinfection rate
indicates that prevention measures should be discussed and regular HCV testing
should be continued after successful treatment.