Two new studies from the Conference on Retroviruses and Opportunistic Infections highlight the issue of HCV reinfection in HIV+ MSM in Europe and the US.
HCV Rates Among HIV-infected Men who have Sex with Men
Conference on Retroviruses and Opportunistic Infections, Seattle, Washington, March 4-7, 2019
Across the Pond: DAA Experience in London.1 Wide scale introduction of DAAs started in London in late 2015. A new retrospective study examined HCV incidence before and after this introduction at 3 HIV clinics from July 2013 to June 2018. The aim of the study was to examine the effect of HCV treatment access and risk-behavior modification on HCV first and reinfection incidence among HIV-infected MSM.
Concerning Rise in Reinfections. The study identified 293 acute HCV infections (246 first infections and 47 reinfections). Incidence of first HCV infection peaked in 2015, when DAAs were introduced. Since then, there has been a 74% decrease in incidence of first infection and a 62% decrease in overall incidence, however, reinfection rates rose from 9% to 16%.
The Home Front: New York City.2 A new study provided the first data on HCV reinfection among HIV-infected MSM in NYC. The prospective analysis included 267 HIV-infected MSM with HCV clearance (SVR 12 by treatment or undetectable HCV viral load for ≥12 wks by SC). The clinical onset of reinfection was defined as first ALT elevation or HCV viremia; median follow-up was 1.8 years.
Reinfections Occur Regardless of Initial Treatment Type. There was 44 reinfections in 38 men with an overall reinfection rate of 5.7/100 person years; median onset of reinfection was 1.5 years after clearance. There was no significant difference found between infections cleared by interferon (37%), DAA (53%), or SC (9%) (p=0.52). Also, there was no significant difference in time to reinfection based on treatment (p=0.82).
Take Home Points. HCV reinfection in HIV-infected MSM is a problem both in Europe and the US. In London, acute HCV infections among HIV-infected MSM decreased, which coincided with wider access to DAA treatment, but reinfections are on the rise. In New York City, HIV-infected MSM have a high HCV reinfection rate, independent of initial treatment type. Monitoring and interventions are needed to decrease HCV-reinfection rates and ongoing transmission among HIV-infected MSM.
1. LJ Garvey, CJ Smith, C Stingone, et al. Fall in HCV incidence in HIV+ MSM in London following wider access to DAA therapy. Abstract presented at: Conference on Retroviruses and Opportunistic Infections 2019; March 2019; Seattle, Washington.
2. Carollo JR, Factor SH, G Rodriguez-Caprio, et al. HCV reinfection among HIV-infected MSM in New York City. Abstract presented at: Conference on Retroviruses and Opportunistic Infections 2019; March 2019; Seattle, Washington.
Research presented at the Conference on Retroviruses and Opportunistic Infections in Seattle, Washington from March 4-7, 2019, suggests that the hepatitis C virus (HCV) epidemic among men who have sex with men (MSM) has changed, reflecting improved linkage to care and access to direct acting antivirals (DAAs). In London, rates of first HCV infections are decreasing but rates of reinfection are climbing; in New York City, HCV reinfection continues to be high. Results of both studies, summarized below, suggest the need for long-term monitoring and interventions among HIV-infected MSM with current or past HCV infection.