| |
Prevalent and Incident Hepatitis C Virus Infection among HIV-Infected Men Who Have Sex with Men Engaged in Primary Care in a Boston Community Health Center....'Worrisome Trend'
|
| |
| |
Download the PDF here
Clinical Infectious Diseases Advance Access published February 5, 2013
Shikha Garg1,2, Lynn E. Taylor2, Chris Grasso3, Kenneth H. Mayer3,4
1Tufts Medical Center, Boston, MA, USA
2Brown University, Providence, RI, USA
3The Fenway Institute, Boston, MA, USA
4Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
Summary: This study found a high incidence of hepatitis C virus infection among a sample of HIV-infected MSM engaged in primary care in Boston, Massachusetts, in the absence of traditional risk factors such as injection drug use.
....HIV+ MSM at Boston Fenway Clinic 6% tested HCV+, among those testing negative who were subsequently retested over several years 6% were HCV+. "HIV+ MSM should receive annual HCV screening to diagnose and treat infection at earlier stages; higher-risk patients should be screened more often"....CDC should recommend this
We should add language in HIV Guidelines regarding HAC screening, the CDC, HHS or Congress & advocates can make this happen. Right now CDC recommends a baseline HCV test for all with HIV, but the link to the study below reports 30% of HIV+ patients say they did not get tested, also regarding HIV+ MSM, the other study below reports 6% of HIV+ MSM at Boston Fenway Clinic had HCV from an initial screen and among those who received subsequent screening 6% were HCV+. So this highlights a new development & trend in HIV+ MSM, that more HIV+ MSM are recently increasingly getting HCV. But also over recent years there have been numerous studies reporting female sex partners of HIV+ IDUs with no reported history of IDU are contracting HCV. Currently the CDC recommends baseline HCV screening for all HIV+ but (1) is this being adhered to totally, and (2) the study below just published in CID is the most recent of several studies showing here in the USA, not just in Europe, increasing HIV+ MSM are contracting HCV. So it is time to push for adding language to CDC, HHS & Ryan White Care Act documents that there should be annual HCV screening for all, and certainly for all with a history of risk factors which include MSM, sex with someone who was at risk (IDU, MSM), and IDU history, but of course this includes almost everyone & many people may not admit to certain behaviors SO we should have langauge that everyone with HIV should be tested annually for HCV !!!! Jules Levin, NATAP
LANGUAGE:
Adding annual
HCV antibody testing to the US Federal Ryan White Program
would permit earlier identification of undiagnosed HCV infection
and create an instant widespread surveillance system, providing
HCV incidence data.
"......almost one-third of the chronically infected patients said that they had never been given a diagnosis of HCV......more likely to be female, black, older.....[IS IT] failure of physicians to test for HCV, lack of communication, miscommunication, or denial....Our results underscore the urgency of efforts to screen AIDS patients for HCV and to make sure that the test results and their implications are clearly communicated..........The Department of Health and Human Services Guidelines for the prevention of opportunistic infections among HIV-infected persons issued in 2002 advised screening for HCV in all HIV-infected persons.....Our results underscore the urgency of efforts to screen AIDS patients for HCV and to make sure that the test results and their implications are clearly communicated. A new era of HCV treatment with direct acting antiviral drugs has just begun. More effective treatments for both HIV and HCV will undoubtedly decrease mortality in HCV-positive patients with a diagnosis of AIDS. Early cure of HCV may avoid the costs of liver transplantation, which exceeds $123,000 per patient [38]. Broader screening and more patient education are needed to maximize the benefits of new treatments and to lower liver-related mortality."
Mortality in HCV-infected Patients with a Diagnosis of AIDS in the Era of Combination Anti-retroviral Therapy
http://www.natap.org/2012/HCV/050712_03.htm
....HIV+ MSM at Boston Fenway Clinic 6% tested HCV+, among those testing negative who were subsequently retested over several years 6% were HCV+. .....the HCV+ MSM in this study...."tended to be younger and to have a higher frequency of STIs.....reported a history of only NIDU [non-injection drug use].....Among non-injection drug users, cocaine was the most commonly reported substance used......Non-medical use of erectile enhancing agents has been implicated in transmission of HIV and other STIs among MSM, and may be a marker of a riskier subset of patients in care.....One-third of HCV-infected MSM in this study also used erectile enhancing medications despite the younger age of the cohort.......Among HIV-infected MSM, factors that have been associated with sexually transmitted HCV include concurrent anogenital infections, unprotected receptive anal intercourse, group sex and other traumatic sexual practices, as well as NIDU, particularly sex while high on methamphetamines.....Of the 23 men with incident HCV [in this study], the median baseline ALT (closest to the date of last negative HCV Ab) prior to HCV Ab seroconversion was 29 IU/L......HIV-infected MSM should receive annual HCV Ab screening to diagnose and treat infection at earlier stages; higher-risk patients should be screened more often....HIV-infected MSM should receive annual HCV Ab screening to diagnose and treat infection at earlier stages; higher-risk patients should be screened more often" [from Jules: the CDC should recommend rescreening]........"Phylogenetic analyses of HIV-infected MSM with recent HCV acquisition from Europe and Australia suggest the presence of an international HCV transmission network [4]. Studies are ongoing to determine whether similar networks exist within the United States [24, 25]."
"findings support the growing body of evidence that the epidemiology of HCV infection may be changing among HIV-infected MSM in the United States. In the absence of IDU, high risk sexual behaviors and NIDU (non-injection drug use) appear to play an important role in transmission......{in this published study] Of 1171 HIV-infected men, of whom 96% identify as MSM, 1068 (91%) were screened for HCV and 64 (6%) had a positive HCV antibody (Ab) result at initial screening. Among the 995 men whose initial HCV Ab was negative, 62% received no further HCV Ab testing. Among the 377 men who had ≥1 additional HCV Ab test, 23 (6%) seroconverted over 1,408 person-years, for an annualized incidence of 1.63/100 person-years. Among the 87 HIV-infected MSM diagnosed with prevalent or incident HCV, 33% reported history of injection drug use, 46% non-injection drug use (NIDU) and 70% sexually transmitted infections (STI). Sixty-four (74%) of HCV-infected MSM developed chronic HCV; 22 (34%) initiated HCV treatment and 13 (59%) of treated persons achieved a sustained virologic response (SVR)........since patients and providers may be unaware of the risk of HCV transmission in the setting of these non-traditional risk factors [27, 28], early screening may be uncommon ....... HIV-infected MSM should receive annual HCV Ab screening to diagnose and treat infection at earlier stages; higher-risk patients should be screened more often .....[in this study] men who reported sex with men as their only risk factor for HIV acquisition were more likely to have had at least 1 HCV Ab test compared to men who reported sex with men plus IDU as a risk factor for HIV acquisition......European guidelines since 2008 have recommended annual HCV screening among HIV-infected individuals with a negative HCV Ab [29]. In contrast, U.S. HIV primary care guidelines endorse HCV Ab screening at the time of HIV diagnosis but lack recommendations for repeated screening among individuals with a negative HCV Ab test [30].....While baseline screening for HCV will diagnose infection acquired either prior to or at the time of HIV acquisition, HCV acquired after HIV infection is typically clinically silent [31], and may not be diagnosed until late in its clinical course without rescreening. The Centers for Disease Control and Prevention (CDC) now recommends routine ongoing HCV testing among HIV-infected MSM with high risk sexual behaviors or concomitant ulcerative STIs [from Jules: but as far as I know we don't have rescreening recommendations for HIV+ which the CDC should recommend].....Given that the addition of the HCV protease inhibitors improves SVR rates in patients with genotype 1 infection [39], earlier recognition and treatment of HCV infection may greatly improve outcomes"
"The annualized incidence of HCV among this sample of HIV-infected MSM engaged in primary care in Boston, Massachusetts was 1.63/100 person-years. To our knowledge, this is the highest HCV incidence reported in the United States among HIV-infected MSM to date and suggests that incident HCV is common in this population. Studies from Europe and Australia have demonstrated a similarly high incidence of HCV among HIV-infected MSM [2, 3, 5, 7, 10, 23]. In a recent study which utilized data from 12 European cohorts, HCV incidence was found to increase over time from 0.09-0.22/100 person-years in 1990 to 2.34-5.11/ 100 person-years in 2007 [16]. Phylogenetic analyses of HIV-infected MSM with recent HCV acquisition from Europe and Australia suggest the presence of an international HCV transmission network [4]. Studies are ongoing to determine whether similar networks exist within the United States.......those with incident HCV tended to be younger and to have a higher frequency of STIs other than HIV......These findings are consistent with other studies of acute or recently acquired HCV infection, in which the median age of HCV acquisition among HIV-infected MSM ranged from 35-40 years [4, 25]. Among HIV-infected MSM, factors that have been associated with sexually transmitted HCV include concurrent anogenital infections, unprotected receptive anal intercourse, group sex and other traumatic sexual practices, as well as NIDU, particularly sex while high on methamphetamines.......One-third of HCV-infected MSM in this study also used erectile enhancing medications despite the younger age of the cohort. Non-medical use of erectile enhancing agents has been implicated in transmission of HIV and other STIs among MSM, and may be a marker of a riskier subset of patients in care [26]. Our findings support the growing body of evidence that the epidemiology of HCV infection may be changing among HIV-infected MSM in the United States. In the absence of IDU, high risk sexual behaviors and NIDU appear to play an important role in transmission. Importantly, since patients and providers may be unaware of the risk of HCV transmission in the setting of these non-traditional risk factors [27, 28], early screening may be uncommon."
"In the United States and other regions where HIV-infected individuals have access to highly active antiretroviral therapy, HCV is a leading cause of non-AIDS related mortality [42] Increasing evidence supports a high prevalence and incidence of HCV infection among HIV-infected MSM. In order to reduce the morbidity and mortality associated with chronic HIV/HCV coinfection, HIV-infected MSM should receive annual HCV Ab screening to diagnose and treat infection at earlier stages; higher-risk patients should be screened more often [43]. Furthermore, HIV-infected MSM who use recreational drugs and/or engage in unprotected sex should receive education and services related to sexual risk reduction, be offered counseling and treatment for substance use and addiction, and be made aware of non-classic risk factors for HCV. Such preventative interventions are crucial to stemming the ongoing spread of HCV."
"Of the 379 men who had one or more subsequent HCV Ab tests after an initial negative result, 255 were tested twice, 85 were tested 3 times, and 37 were tested 4 or more times over a maximum 12 year period......Twenty-three (6%) of 379 men seroconverted to HCV Ab-positive during 1,408 person-years of follow-up, for an incidence of 1.63 per 100 person-years (95% CI 0.97-2.30). Of the 23 men with incident HCV, the median baseline ALT (closest to the date of last negative HCV Ab) prior to HCV Ab seroconversion was 29 IU/L (range 10 IU/L-95 IU/L) and the median peak ALT documented prior to HCV Ab seroconversion was 206 IU/L (range: 16 IU/mL-1124 IU/L)......Among non-injection drug users, cocaine was the most commonly reported substance used. The majority of men had a history of at least one STI beside HIV. Men with incident HCV were younger (37 versus 44 years; p<0.01) and a higher proportion had an STI history other than HIV compared to men with prevalent HCV (87% versus 64%; p=0.04)......Sixty-four (74%) men who were seropositive for HCV developed chronic HCV infection"
Abstract
Background. Sexually transmitted hepatitis C virus (HCV) infection is an emerging epidemic among HIV-infected men who have sex with men (MSM). HCV may be under-recognized in this population, historically thought to be at low risk.
Methods. We determined the prevalence and incidence of HCV among HIV-infected men at Fenway Health between 1997 and 2009. We describe characteristics associated with HCV.
Results. Of 1171 HIV-infected men, of whom 96% identify as MSM, 1068 (91%) were screened for HCV and 64 (6%) had a positive HCV antibody (Ab) result at initial screening. Among the 995 men whose initial HCV Ab was negative, 62% received no further HCV Ab testing. Among the 377 men who had ≥1 additional HCV Ab test, 23 (6%) seroconverted over 1,408 person-years, for an annualized incidence of 1.63/100 person-years (95% CI 0.97-2.30). Among the 87 HIV-infected MSM diagnosed with prevalent or incident HCV, 33% reported history of injection drug use, 46% non-injection drug use (NIDU) and 70% sexually transmitted infections (STI). Sixty-four (74%) of HCV-infected MSM developed chronic HCV; 22 (34%) initiated HCV treatment and 13 (59%) of treated persons achieved a sustained virologic response (SVR).
Conclusion. Prevalent and incident HCV, primarily acquired through non-parenteral means, was common in this HIV-infected population despite engagement in care. STIs and NIDU were common among HIV/HCV coinfected MSM. SVR rates were high among those who underwent HCV treatment. All sexually active and/or substance-using HIV-infected MSM should receive routine and repeated HCV screening to allow for early diagnosis and treatment of HCV.
Introduction
Although injection drug use (IDU) is the principal mode of hepatitis C virus (HCV) transmission in the United States, 10-40% of persons in many epidemiologic studies have no identifiable parenteral source of infection [1]. Among HIV-infected men who have sex with men (MSM), evidence is accumulating that HCV transmission may be facilitated by traumatic sexual practices [2-11] and non-injection drug use (NIDU) [12, 13], in the absence of IDU.
While the epidemiology of HCV among HIV-infected injection drug users is well described, less is known about the prevalence and incidence of HCV among HIV-infected MSM in the United States. A study of HIV-infected male participants in the U.S. AIDS Clinical Trial Group Longitudinal Linked Randomized Trials Cohort found an annualized HCV incidence of 0.5/100 person-years between 1996 and 2008. Notably, 75% of seroconverters reported no history of IDU [14] but this sample might not reflect the diversity of HIV-infected MSM in care. A study conducted among non-injection drug-using HIV-infected MSM in San Francisco found HCV seroprevalence to decline from 8.7% in 2004 to 4.5% in 2008 [15]. These findings contrast with multiple European studies that have identified an increasing incidence of HCV among HIV-infected MSM [16, 17]. An important barrier to assessing the burden of HCV among HIV-infected MSM in the United States is that rates of initial and repeat HCV antibody (Ab) screening in this population remain low [18].
Fenway Health, in Boston, Massachusetts, provides care to over 20,000 patients, of whom about 50% are MSM and other sexual and gender minorities [19]. An estimated 96% of HIV-infected men who seek care at Fenway Health identify as MSM. Among the >1,750 HIV-infected MSM in care at Fenway Health, the prevalence of self-reported IDU is < 3%. This large sample of non-injection drug using, HIV-infected MSM, who are engaged in care at a single site, offers a unique opportunity to explore the epidemiology of HCV among a population of patients previously perceived to be at low risk.
DISCUSSION
The annualized incidence of HCV among this sample of HIV-infected MSM engaged in primary care in Boston, Massachusetts was 1.63/100 person-years. To our knowledge, this is the highest HCV incidence reported in the United States among HIV-infected MSM to date and suggests that incident HCV is common in this population. Studies from Europe and Australia have demonstrated a similarly high incidence of HCV among HIV-infected MSM [2, 3, 5, 7, 10, 23]. In a recent study which utilized data from 12 European cohorts, HCV incidence was found to increase over time from 0.09-0.22/100 person-years in 1990 to 2.34-5.11/ 100 person-years in 2007 [16]. Phylogenetic analyses of HIV-infected MSM with recent HCV acquisition from Europe and Australia suggest the presence of an international HCV transmission network [4]. Studies are ongoing to determine whether similar networks exist within the United States [24, 25].
Compared with HIV-infected MSM with prevalent HCV, those with incident HCV tended to be younger and to have a higher frequency of STIs other than HIV. Only one third of HIV-infected MSM with either prevalent or incident HCV reported a history of IDU, while many more reported a history of only NIDU. These findings are consistent with other studies of acute or recently acquired HCV infection, in which the median age of HCV acquisition among HIV-infected MSM ranged from 35-40 years [4, 25]. Among HIV-infected MSM, factors that have been associated with sexually transmitted HCV include concurrent anogenital infections, unprotected receptive anal intercourse, group sex and other traumatic sexual practices, as well as NIDU, particularly sex while high on methamphetamines [5, 8, 10, 11, 23, 25]. One-third of HCV-infected MSM in this study also used erectile enhancing medications despite the younger age of the cohort. Non-medical use of erectile enhancing agents has been implicated in transmission of HIV and other STIs among MSM, and may be a marker of a riskier subset of patients in care [26]. Our findings support the growing body of evidence that the epidemiology of HCV infection may be changing among HIV-infected MSM in the United States. In the absence of IDU, high risk sexual behaviors and NIDU appear to play an important role in transmission. Importantly, since patients and providers may be unaware of the risk of HCV transmission in the setting of these non-traditional risk factors [27, 28], early screening may be uncommon.
In this study, 9% of HIV-infected MSM did not have a documented HCV Ab test at any point in the study, and 62% had only an initial negative HCV Ab test with no subsequent testing despite long-term follow-up care at this clinic. This low rate of repeat HCV Ab testing may in part be due to healthcare provider perceptions that their patients are at low risk for HCV. Of the patients with incident HCV, many lacked documented evidence of a preceding rise in ALT or clinical exposure history to HCV, either of which might have prompted clinicians to order HCV Ab testing. Incident HCV infection may remain undiagnosed in this group of patients if risk-based testing or testing based on ALT rise alone is utilized. European guidelines since 2008 have recommended annual HCV screening among HIV-infected individuals with a negative HCV Ab [29]. In contrast, U.S. HIV primary care guidelines endorse HCV Ab screening at the time of HIV diagnosis but lack recommendations for repeated screening among individuals with a negative HCV Ab test [30]. While baseline screening for HCV will diagnose infection acquired either prior to or at the time of HIV acquisition, HCV acquired after HIV infection is typically clinically silent [31], and may not be diagnosed until late in its clinical course without rescreening. The Centers for Disease Control and Prevention (CDC) now recommends routine ongoing HCV testing among HIV-infected MSM with high risk sexual behaviors or concomitant ulcerative STIs [32]. CDC also now recommends screening all Americans born between 1945 and 1965 (the "baby boomers") [33].
In this study, 59% of HIV-infected MSM with chronic HCV infection who underwent treatment achieved SVR, despite a high prevalence of genotype 1 infection and elevated baseline HCV RNA. This SVR rate is higher than previously reported among HIV-infected persons with chronic HCV [34] and may in part be explained by an earlier stage of fibrosis at the time of treatment. A shorter duration of HCV infection at the time of treatment and higher treatment completion rates may also have contributed to the high SVR rate. In addition, much of the earlier data on HCV treatment response rates in coinfected individuals involved patients who were older and of African American ancestry [35, 36]. The high SVR rate observed may reflect more optimal HCV treatment responses with interferon-based treatment among patients who are younger and Caucasian. Finally, provider experience at Fenway Health and the coinfections-pecific referral center may have contributed to increased HCV treatment rates and improved outcomes [37, 38]. Given that the addition of the HCV protease inhibitors improves SVR rates in patients with genotype 1 infection [39], earlier recognition and treatment of HCV infection may greatly improve outcomes.
Several study limitations should be noted. Data collection was based upon retrospective chart review and may not have captured risk factor data that was undocumented by providers. Data on alcohol use was not systematically documented and was not included in this analysis. Data on IDU and NIDU was based upon patient self-report and may have under-estimated the true prevalence of substance use as well as the contribution of substance use to HCV acquisition in this population. However, audio-computer-assisted interview methods are employed at Fenway Health to collect behavioral data [40, 41] and have been shown to be effective in increasing the reporting of risky or undesirable behaviors. Although 96% of HIV-infected men at Fenway Health identify as MSM, current sexual behavior data were not available for all individuals. While all 87 men with HCV were MSM, some non-MSM patients may have been included in the denominator which included all male HIV-infected patients in care, suggesting that annualized HCV incidence might actually be higher for HIV-infected MSM. Nine percent of patients at Fenway Health did not receive an HCV Ab test and the remaining patients had variable HCV Ab testing over the study period, with the majority of patients undergoing a single negative screening test. Thus, we may have under-estimated true HCV Ab prevalence and incidence among HIV-infected MSM at Fenway Health. Given that data was retrospectively collected, we were unable to determine whether patients with incident HCV had recent acute versus chronic HCV infection; thus, some patients may have been miss-classified. Finally, while we included data on baseline CD4+ cell count and HIV viral load in our analyses, we were unable to assess the association between antiretroviral therapy use and HCV Ab testing, disease progression and treatment outcomes.
In the United States and other regions where HIV-infected individuals have access to highly active antiretroviral therapy, HCV is a leading cause of non-AIDS related mortality [42] Increasing evidence supports a high prevalence and incidence of HCV infection among HIV-infected MSM. In order to reduce the morbidity and mortality associated with chronic HIV/HCV coinfection, HIV-infected MSM should receive annual HCV Ab screening to diagnose and treat infection at earlier stages; higher-risk patients should be screened more often [43]. Furthermore, HIV-infected MSM who use recreational drugs and/or engage in unprotected sex should receive education and services related to sexual risk reduction, be offered counseling and treatment for substance use and addiction, and be made aware of non-classic risk factors for HCV. Such preventative interventions are crucial to stemming the ongoing spread of HCV.
RESULTS
Of the 1169 HIV-infected men seen at least twice between January 2008 and June 2009, nine men were excluded who did not identify as MSM. Of the remaining 1160 men, 1059 (91%) had at least one HCV Ab test (Figure 1). The 101 (9%) HIV-infected men who were not tested for HCV did not differ from those who were tested for HCV by age, race, or baseline CD4+ cell count. However, men who reported sex with men as their only risk factor for HIV acquisition were more likely to have had at least 1 HCV Ab test compared to men who reported sex with men plus IDU as a risk factor for HIV acquisition (p=<0.01). Men who had a baseline HIV viral load >10,000 copies/mL were more likely to have had at least 1 HCV Ab test compared to those who had an undetectable HIV viral load (p=0.01) (data not shown).
Among the 1059 men who had at least one HCV Ab test, 38 (4%) were found to have a positive HCV Ab on initial testing, 26 (2%) were known to be HCV-seropositive prior to entry into care, and 995 (94%) were found to have a negative HCV Ab on initial testing. Among the 995 men with an initial negative HCV Ab, 616 (62%) were not re-tested. In comparing the 616 men who only had one HCV Ab test with the 379 men who had ≥ 2 HCV Ab tests, there were no significant differences in race, risk factor for HIV acquisition and initial CD4+ cell count (Table 1). However, men with an HIV viral load of up to 10,000 copies/mL were more likely to have >1 HCV Ab test compared with men who had an undetectable HIV viral load (p<0.01).
Of the 379 men who had one or more subsequent HCV Ab tests after an initial negative result, 255 were tested twice, 85 were tested 3 times, and 37 were tested 4 or more times over a maximum 12 year period. The median time between HCV antibody tests was comparable between men who seroconverted (2.5 years) and those who didn't (2.8 years) (p=0.59). Among the 379 men with two or more HCV Ab tests, 27 were diagnosed with HIV infection after entry into care at Fenway Health. We excluded person-time from entry into care at Fenway Health until HIV diagnosis for these 27 men. Twenty-three (6%) of 379 men seroconverted to HCV Ab-positive during 1,408 person-years of follow-up, for an incidence of 1.63 per 100 person-years (95% CI 0.97-2.30).
Of the 23 men with incident HCV, the median baseline ALT (closest to the date of last negative HCV Ab) prior to HCV Ab seroconversion was 29 IU/L (range 10 IU/L-95 IU/L) and the median peak ALT documented prior to HCV Ab seroconversion was 206 IU/L (range: 16 IU/mL-1124 IU/L).
The annual number of HCV Ab tests among men at Fenway Health increased from 40 tests in 1997 to 213 tests in 2009 (p < 0.01). Overall the percentage of HCV Ab tests that were positive did not increase between 1997 and 2009, ranging from 3% to 8% (p=0.57). However, among the 23 men with incident HCV, the number of cases diagnosed increased over time: 6 seroconverted from 2001-2004, 4 seroconverted in 2007, 5 seroconverted in 2008 and 8 seroconverted in 2009 (p <0.01).
Among men with incident or prevalent HCV, 33% reported a history of IDU, 46% reported a history of NIDU, 16% reported no drug use, and substance use history was unknown for 5% (Table 2). Among non-injection drug users, cocaine was the most commonly reported substance used. The majority of men had a history of at least one STI beside HIV. Men with incident HCV were younger (37 versus 44 years; p<0.01) and a higher proportion had an STI history other than HIV compared to men with prevalent HCV (87% versus 64%; p=0.04).
Sixty-four (74%) men who were seropositive for HCV developed chronic HCV infection (Table 3). Of these, 47 had prevalent and 17 have incident HCV infection. Among men who underwent HCV treatment, SVR rates were higher for those with incident HCV infection [6/7 (86%)] compared to those with prevalent HCV infection [7/15 (47%)] (p= 0.02). Of 16 men with a known date of initial HCV diagnosis and HCV treatment start date, the median time from HCV diagnosis to treatment initiation was 14 months (range: 2-67 months); the median time was 6 months (range: 2-67 months) among 10 of 16 men who achieved SVR compared with 18 months (range: 14-35 months) among 6 of 16 men who did not achieve SVR (p=0.33).
Twenty-six men with chronic HCV infection underwent liver biopsy; 13 (50%) had stage 0-1, 5 (19%) had stage 2, and 8 (31%) had stage 3-4 liver fibrosis [Metavir scoring system]. Among 16 of 47 men with prevalent HCV infection, the median time from HCV diagnosis to liver biopsy was 2.8 years (range: 0.1-11.3 years); among 7 of 17 men with incident HCV infection, the median time from HCV diagnosis to liver biopsy was 0.3 years (range: 0.2-4.5 years) (p=0.53).
Among 51 men with chronic HCV infection who did not initiate treatment or who were treated but did not achieve SVR, the median APRI score was 1.22 (range 0.12-6.09); 22 (43%) had a score < 0.5, 20 (39%) had a score between 0.5- 1.5, and 9 (17.6%) had a score > 1.5.
|
|
| |
| |
|
|
|
