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HCV incidence in HIV-infected and in PrEP-using MSM
- New HCV Rate Similar in HIV+ MSM and HIV- MSM on PrEP in France
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25th Conference on Retroviruses and Opportunistic Infections (CROI), March 4-7, 2018, Boston
Mark Mascolini
One in every 100 HIV-positive men who have sex with men (MSM) in France gets a first HCV infection every year, according to a 10,537-man Dat'AIDS analysis [1]. Incidence of first HCV infection is the same among HIV-negative MSM using preexposure prophylaxis (PrEP) to prevent HIV infection.
Although HCV incidence--the new-infection rate--dropped in some countries with wide use of direct-acting antivirals (DAAs) [2], that has not happened in France. Dat'AIDS researchers also reported at CROI that HCV incidence among HIV-positive MSM continued to rise in France from 2012 through 2016 [3].
This analysis compared rates of first HCV infection in two groups: HIV-positive MSM and HIV-negative PrEP-using MSM. At 16 centers across France, Dat'AIDS represents about 25% of all HIV-positive people in care. Dat'AIDS investigators focused on HIV-positive/HCV-negative men in care in 2016 and HIV-negative/HCV-negative MSM PrEP users enrolled from January 2016 to May 2017. Because recruitment of PrEP users proved highly variable across sites, the researchers also conducted a subanalysis at 5 sites with the most PrEP users.
The study included 10,537 men with HIV and 930 HIV-negative PrEP users. Median ages in the HIV-positive and negative groups were 41 (interquartile range [IQR] 50 to 57) and 37 (IQR 30 to 45). Of the men with HIV, 98% were taking antiretroviral therapy, 90% had an HIV load below 50 copies, and median CD4 count stood at 505.
Among the 10,537 men with HIV, Dat'AIDS investigators had HCV data on 10,049, of whom 681 already had HCV when entering the study to yield an HCV prevalence of 6.4%. HCV follow-up data were available in 2016 for 4151 HCV-negative men, and virologic data were available for 478 men already cured of HCV. Among men with follow-up, 57 had acute HCV infection, including 42 first infections and 15 reinfections of men already cured of one HCV episode. Incidence of first HCV infection stood at 1.01 per 100 person-years; incidence of reinfection was 3.14 per 100 person-years; and overall acute HCV incidence was 1.23 per 100 person-years. An incidence of 1.01 per 100 person-years means 1 of every 100 men acquires HCV infection every year.
Among the 930 PrEP-using MSM, researchers had HCV status data for all men and follow-up data for 916. When entering the study, 17 men already had HCV infection to yield a prevalence of 1.8% in these HIV-negative PrEP users. During follow-up there was 12 acute HCV infections, including 10 first infections and 2 reinfections. Incidence of first HCV infection measured 1.03 per 100 person-years, and overall acute HCV incidence measured 1.24 per 100 person-years. (Researchers did not figure reinfection incidence in this group because there were too few cases.)
The 5-site subanalysis included 44% of all men with HIV and 90% of all PrEP users. Overall acute HCV incidence stood at 1.47 per 100 person-years in HIV-positive men and 1.38 per 100 person-years in HIV-negative PrEP users.
Similar incidence of first HCV and all acute HCV in HIV-positive MSM and HIV-negative PrEP-using MSM, the Dat'AIDS team observed, probably means these two groups "share similar at-risk practices for HCV and should be targeted for preventive interventions."
References
1. Cotte L, Cua E, Reynes J, et al. HCV incidence in HIV-infected and in PrEP-using MSM. 25th Conference on Retroviruses and Opportunistic Infections (CROI). March 4-7, 2018. Boston. Abstract 590.
2. Braun DL, Hampel BH, Nguyen H, et al. A treatment as prevention trial to eliminate HCV in HIV+ MSM: the Swiss HCVree Trial. 25th Conference on Retroviruses and Opportunistic Infections (CROI). March 4-7, 2018. Boston. Abstract 81LB.
3. Cotte L, Huleux T, Raffi F, et al. HCV incidence is still increasing in French HIV-infected MSM. 25th Conference on Retroviruses and Opportunistic Infections (CROI). March 4-7, 2018. Boston. Abstract 591.
CROI: New HCV Infections Still Rising Among MSM With HIV in France - (03/21/18)
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APASL: Safety, Pharmacokinetics and Antiviral Activity of Novel HBV Capsid Assembly Modulator, JNJ-56136379, in Non-cirrhotic, Treatment-naïve Patients with Chronic Hepatitis B - (03/21/18)
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