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HOMOSEXUALLY TRANSMITTED HCV-ACUTE INFECTION RELATED TO A CLUSTERED GENOTYPE 4 HCV IN HIV-1 INFECTED MEN AND INEFFICACY OF EARLY ANTIVIRAL THERAPY
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J. Serpaggi1, M.L. Chaix2, D. Batisse3, C. Dupont4, A. Vallet-Pichard1, H. Fontaine1, J.P. Viard5, C. Piketti3, E. Rouveix4, C. Rouzioux2, L. Weiss3, S. Pol1
1 Unitˇ d'Hˇpatologie - INSERM U 370, CHU Necker Enfants-Malades, Paris, France
2 Laboratoire de Virologie-EA 3620 Universitˇ Renˇ Descartes-CHU Necker
Enfants-Malades, Paris, France
3 Infectious Disease Unit, Georges Pompidou Hospital, Paris, France
4 Infectious Disease Unit, Ambroise Parˇ Hospital, Paris, France
5 Maladies Infectieuses, CHU Necker Enfants-Malades, Paris, France
Background: HCV sexual transmission remains controversial. Recent studies suggest an increase of acute hepatitis C infections in homosexual HIV-infected men. While early treatment of acute hepatitis C with interferon significantly reduces the risk of chronic evolution in immunocompetent patients, efficacy of such a treatment is not known in HIV-infected patients. Here, we report twelve cases of sexually transmitted hepatitis C in HIV-1 infected men.
Methods: Analysis of twelve HIV-1 infected patients who were diagnosed with acute hepatitis C, defined by both seroconversion of anti-HCV antibodies and detection of serum HCV RNA in previously anti-HCV and HCV RNA negative patients. Genotyping of HCV isolates (INNOLIPA) revealed 1 genotype 1a, 1 genotype 3 and 10 genotype 4d infections. For the 10 4d cases, the non-structural 5B gene was amplified and sequenced for phylogenetic analysis. Ten out of the 12 patients received early antiviral treatment with standard interferon or PEG-interferon alone or in combination with ribavirin.
Results: Homosexual exposure was the only significant risk factor reported in this population. Acute hepatitis C was symptomatic in only 2 patients. For the remaining patients, diagnosis of acute HCV hepatitis was done on systematic screening. The 10/12 frequency of genotype 4 in acute hepatitis strikingly contrasted with the less than 15% reported in chronic hepatitis of HCV-HIV co-infected patients. The 10 genotype 4d viruses formed a monophylogenetic group and clustered separately from other local sequences of HCV genotype 4d with a bootstrap value of 90%, suggesting a common source of infection, as confirmed by the method of maximum of likelihood. Recent infection was confirmed by the very short evolutionary distances between the strains. None of the 10 patients treated with early antiviral therapy had a sustained virological response.
Conclusions: These results demonstrate: 1. a risk of sexual transmission of HCV in HIV-infected men who have sex with men; 2. a cluster of HCV genotype 4d suggesting a common source of infection and the breakthrough of preventing counseling; 3. an inefficacy of early treatment with standard interferon of acute hepatitis C in HIV-infected patients to prevent chronic evolution of hepatitis C.
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