HCV reinfection incidence and spontaneous clearance rates in HIV-positive men who have sex with men in Western Europe.
Ingiliz P et al
J Hepatol 2017 ;66 :282-7.

Background & Aims: Moderate cure rates of acute hepatitis C virus (HCV) infections with pegylated interferon and ribavirin have been described in the last decade in men who have sex with men (MSM), who are also coinfected with the human immunodeficiency virus (HIV). However, a subsequent high incidence of HCV reinfections has been reported regionally in men who both clear the infection spontaneously or who respond to treatment.

Methods: Retrospective analysis of reinfections in HIV infected MSM in eight centers from Austria, France, Germany, and the UK within the NEAT network between May 2002 and June 2014.

Results: Of 606 individuals who cleared HCV spontaneously or were successfully treated, 149 (24.6%) presented with a subsequent HCV reinfection. Thirty out of 70 (43%) who cleared again or were successfully treated, presented with a second reinfection, 5 with a third, and one with a fourth reinfection. The reinfection incidence was 7.3/100 person-years (95% CI 6.2–8.6). We found a trend for lower incidence among individuals who had spontaneously cleared their incident infection than among individuals who were treated (Hazard ratio 0.62, 95% CI 0.38–1.02, p = 0.06). Spontaneous clearance of reinfection was associated with ALT levels >1000 IU/ml and spontaneous clearance of a prior infection.

Conclusions: HCV reinfection is an issue of major concern in HIVpositive MSM. Prevention strategies are needed for high risk groups to reduce morbidity and treatment costs. HIV-positive MSM with a prior HCV infection should be tested every 3 to 6 months for reinfection. Those who had achieved a reinfection should be tested every 3 months

Expert's Commentary

« The alarming finding of an HCV reinfection rate of almost 25% among HIV-seropositive European MSM clearly underlines that the current outbreak of acute HCV among HIV-infected MSM is still not under control (1). Even more striking is the high second reinfection rate of 43% which demonstrates that there is an absolute lack of successful behavioral interventions which could be implemented. Indeed, the importance of such behavioral interventions was recently outlined in a modelling paper in Hepatology (2). The authors predicted the effect of behavioral and treatment interventions on HCV incidence and prevalence among HIV-infected men who have sex with men up to 2030 using a HCV transmission model parameterized with data from the Swiss HIV Cohort Study. The authors concluded that treatment interventions to curb the HCV epidemic among HIV-infected men who have sex with men are effective if high-risk behavior does not increase as it has during the last decade; reducing high-risk behavior associated with HCV transmission would be the most effective intervention for controlling the HCV epidemic, even if this was not accompanied by an increase in treatment uptake or efficacy. With increased use of chemsex drugs and low usage of condoms also among the increasing group of PREP users more effective behavioral interventions are urgently needed and should be developed with high urgency. »

Pr Jürgen Rockstroh, University of Bonn

1. Ingiliz P, et al. NEAT study group. HCV reinfection incidence and spontaneous clearance rates in HIV-positive men who have sex with men in Western Europe. J Hepatol. 2017 Feb;66(2):282-287
2. Salazar-Vizcaya L, et al. Swiss HIV Cohort Study.. Hepatitis C virus transmission among human immunodeficiency virus-infected men who have sex with men: Modeling the effect of behavioral andtreatment interventions. Hepatology. 2016 Dec;64(6):1856-1869