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Spontaneous HCV Clearance With HIV Lower Than Previously Thought?
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11th European AIDS Conference
October 24-27, 2007
Madrid
Mark Mascolini
Spontaneous clearance of hepatitis C virus (HCV) proved lower in a large 4-center European study than in previous HIV cohort analyses, according to results presented at the 11th European AIDS Conference [1]. The study also showed that rates of sexually transmitted HCV remain high among men who have sex with men (MSM).
Clinicians in London, Paris, and Bonn studied 150 people with acute HCV infection, defined as HCV seroconversion and/or a positive HCV RNA within 12 months of a negative HCV antibody test or a negative HCV PCR. The cohort included 131 MSM and only 5 injecting drug users (IDUs) and 2 IDU MSM. The rest had an unknown or unrecorded HCV risk factor.
Only 32 people (21%) had hepatitis symptoms with their acute infection; most others were diagnosed because of high liver enzymes. Twenty-five people (17%) also had syphilis. Most cohort members, 58%, had HCV genotype 1. Prevalence of that genotype was higher in cohort members from Germany (68%) and the UK (64%) than from France (21%).
Median HCV load at diagnosis stood at 5.93 log IU/L, median HIV load at 2.29 log copies/mL (under 200 copies), median baseline alanine aminotransferase (ALT) at 330 IU/L, and median CD4 count at 433. Two thirds of these people were taking antiretrovirals, and two thirds had an HIV load under 400 copies.
Twelve weeks after diagnosis of acute HCV, negative HCV PCRs indicated that 23 people (15%) had cleared the hepatitis virus. By week 24, 11 more people became HCV RNA negative, but 3 previously negative people became positive. By week 48 only 6 of the 23 people (26%) with apparent viral clearance at week 12 remained HCV PCR negative. The researchers did not know whether relapse or reinfection explained these negative-to-positive shifts.
All told, 11 of 39 people not treated for HCV (28%) and 11 of 150 people overall (7%) had spontaneous HCV clearance at week 48. Among people infected with HCV but not HIV, spontaneous clearance may be as high as 52%, according to Alex Azwa and coworkers on this study. In HIV/HCV-coinfected people, clearance rates vary from 0% to 25% [2,3]. This cohort's 7% overall clearance rate at week 48 clearly lies on the low side of the previously reported HIV/HCV range.
Two factors favored spontaneous HCV clearance at week 12, a lower initial median HCV load (5.3 versus 6.04 IU/L, P = 0.02) and a higher initial median CD4 count (623 versus 426 cells, P = 0.05). Age, peak ALT, and baseline HIV load did not influence HCV clearance at week 12.
At week 48 none of these variables--including initial HCV load and initial CD4 count--made spontaneous HCV clearance more or less likely. But infection with genotype 2, 3, or 4--rather than 1--favored HCV clearance at week 48 (45% for genotypes 2-4 versus 6% for genotype 1, P = 0.01). The study also found strong trends favoring 48-week clearance in people without versus with hepatitis symptoms at diagnosis (37% versus 5%, P = 0.06) and in people taking versus not taking antiretrovirals (38% versus 8%, P = 0.08). Syphilis coinfection did not affect the chance of clearance at week 48.
Because so few people with spontaneous HCV clearance at week 12 maintained clearance for 48 weeks, the researchers urged continued HCV PCR monitoring over time.
References
1. Azwa A, Low E, Guiguet M, et al. The natural history of acute hepatitis C in HIV co-infected individuals: a European collaborative study. 11th European AIDS Conference. October 24-27, 2007. Madrid. Abstract PS8/5.
2. Gilleece YC, Browne RE, Asboe D, et al. Transmission of hepatitis C virus among HIV-positive homosexual men and response to a 24-week course of pegylated interferon and ribavirin. JAIDS. 2005;40:41-46.
3. Luetkemeyer A, Hare CB, Stansell J, et al. Clinical presentation and course of acute hepatitis C infection in HIV-infected patients. JAIDS. 2006;41:31-36.
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