July 11, 2013

Hepatitis C Reinfection Rising Among HIV Patients

Medscape Medical News > Conference News

Neil Canavan

Jul 11, 2013

KUALA LUMPUR, Malaysia — Nearly 25% of HIV patients infected with and subsequently cured of the hepatitis C virus went on to acquire a second or even third infection within 24 months at one hospital in the United Kingdom.

"Liver disease is one of the leading non-AIDS causes of death in HIV-infected individuals," said lead investigator Thomas Martin, from the Chelsea and Westminster Hospital in London, United Kingdom. In fact, hepatitis C accounted for "roughly two thirds of those cases."

These results suggest that much better educational initiatives related to coinfection with HIV and hepatitis C are needed, he noted.

It has previously been shown that coinfection with HIV reduces the spontaneous clearance of hepatitis C infection, reduces the rate of successful treatment, and can lead to a 3-fold increase in the rate of progression to cirrhosis.

However, the extent to which HIV patients are reinfected with hepatitis C has not been established.

To look at this issue, Dr. Martin and his team analyzed reinfection rates in 191 HIV patients with a primary hepatitis C infection treated at the Chelsea and Westminster Hospital.

Dr. Martin presented the results here at the 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention.

“Liver disease is one of the leading non-AIDS causes of death in HIV-infected individuals.”

The researchers defined reinfection as any newly positive hepatitis C virus RNA polymerase chain reaction result 24 weeks or more after the end of hepatitis C treatment, spontaneous clearance of the virus, or the emergence of a different hepatitis C genotype in a 24-month period.

In the study cohort, the rate of hepatitis C reinfection was 7.8 per 100 patient-years (95% confidence interval, 5.8 - 10.5). "That's approximately 5 to 10 times the baseline primary infection incidence of hepatitis C in this population," Dr. Martin explained.

Of the 32 reinfected patients, the hepatitis C infection was cleared with treatment or spontaneous remission in 17 patients. Of those, 8 went on to acquire a third hepatitis C infection, resulting in an infection rate of 23.2 per 100 patient-years.

Overall, the second and third reinfections cleared spontaneously in 20% of patients, and a complete viral clearance was achieved with standard-of-care treatment in 80%.

"We saw no evidence of protective immunity from the initial hepatitis C infection," said Dr. Martin. "In fact, these individuals remain at high risk for reinfection."

Coinfection Education Needed

"We're becoming increasingly aware that gay men have this elevated risk of sexual acquisition of hepatitis C," said Charles Hicks, MD, professor of medicine at Duke University in Durham, North Carolina.

However, the high frequency of reinfection over a fairly short period after the initial hepatitis C diagnosis is "striking," Dr. Hicks told Medscape Medical News. "That was alarming to me. It means we need to do a better job of counseling gay men who have hepatitis C that just because their first infection has been managed successfully, it doesn't mean they are no longer at risk." Prevention here is key.

It also has implications for future monitoring of patients. Typically, an active hepatitis C infection is detected with an antibody test, he explained. "But in cases of previous viral clearance, you're going to have to use an RNA viral load test to find cases of reinfection."

Dr. Marin and Dr. Hicks have disclosed no relevant financial relationships.

7th International AIDS Society (IAS) Conference on HIV Pathogenesis: Abstract TUAB0101. Presented July 2, 2013.

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