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Acute C hepatitis in Japanese HIV-infected patients in this decade
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Reported by Jules Levin
ICAAC 2013 Sept 10-13 Denver. CO
Masahiro Ishikane1, Koji Watanabe1, Kunihisa Tsukada1, Hiroyuki Gatanaga1, Yoshimi Kikuchi1 and Shinichi Oka1
1AIDS Clinical Center(ACC), National Center for Global Health and Medicine (NCGM), Tokyo, Japan
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ABSTRACT
Background
An increasing number of acute C hepatitis (ACH) in HIV-infected men who have sex with men (MSM) has been reported from Western countries. However, reports from East Asian countries are limited.
Methods
A single-center retrospective cohort study was performed in our institution, the largest HIV clinic in Japan. ACH was defined as elevation of alanine transaminase (ALT) >100IU/L accompanied with seroconversion of anti-Hepatitis C virus (HCV) antibody. Incidence, symptoms and treatment outcome of ACH cases between 2001 and 2012 were reviewed with medical records. Data were expressed as median [range] unless otherwise notified.
Results
Thirty four patients were diagnosed as ACH. The incidence of ACH was 2.1 cases per 1,000 person-years. The incidence was slightly higher in recent 5 years than previous 7 years (2.6 versus 1.5/1000 person-years, respectively). Age was 39 years [23-58]. Thirty three (97.1%) were male, including 32 MSM. Twenty eight (82.4%) received antiretroviral therapy at ACH diagnosis. CD4 count and
HIV-RNA (copies/mL) were 366 [167-971] and undetectable (UD) [UD-94,000], respectively. Twenty eight (82.4%) were asymptomatic and diagnosed by chance at their routine visits. Although 5 patients had a history of injecting drug use, the route of HCV transmission was undetermined in all cases. The most frequent HCV genotype was 1b (67.9%). Spontaneous HCV clearance was achieved in 5 cases (CD4 count; 361/ul [184-971]). Treatment with Pegylated
Interferon (Peg-IFN) plus Ribavirin (RBV) was initiated within 48 week in 12 patients. Interval between initial ALT elevation and initiation of IFN treatment was 4.0 months [0.9-6.9].Duration of Peg-IFN treatment was 45 weeks [11-72]. The rate of rapid viral response (RVR), early viral response (EVR) and sustained viral response (SVR) were 27.2%, 63.6% and 77.8%, respectively. Seventeen patients observed without IFN therapy progressed to chronic C
hepatitis.
Conclusions
SVR rate was relatively high in our cases despite mostly HCV genotype 1b. Early treatment with Peg-IFN plus RBV should be considered for favourable response in HIV-infected patients with ACH.
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