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  Conference on Retroviruses
and Opportunistic Infections (CROI)
February 13-16, 2017, Seattle WA
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High and Rising HCV Incidence in San Diego Study of 2395 MSM With HIV
  Conference on Retroviruses and Opportunistic Infections (CROI), February 13-16, 2017, Seattle
Mark Mascolini
HCV incidence--the new-diagnosis rate--stands at 1.2 per 100 person-years in a large study of HIV-positive men who have sex with men (MSM) in San Diego [1]. HCV incidence more than quadrupled from 2000-2003 to 2012-2015.
University of California, San Diego (UCSD) researchers who conducted this study note increasing reports of acute HCV among HIV-positive MSM, but most of these data come from Western Europe. A just-published study found a high HCV reinfection rate among MSM with HIV in Europe: 7.3 per 100 person-years [2]. The UCSD team aimed to extend this research to the United States by assessing trends in a large HIV-positive MSM cohort in San Diego.
The population consists of HIV-positive MSM who attend the largest HIV clinic in San Diego, had a negative anti-HCV test sometime from 2000 through 2015, and had at least one more anti-HCV or HCR RNA test during follow-up through 2015. The researchers defined incident HCV as any positive anti-HCV or HCV RNA result after a negative anti-HCV test.
The study group included 2395 MSM with a median age of 38; two thirds were white, 10% black, and 26% Hispanic. While 42% of men reported methamphetamine use, another 5% both used meth and injected drugs.
Overall HCV incidence stood at 1.185 per 100 person-years, meaning about 1 of every 100 HIV-positive men acquired HCV infection every year. Compared with men who never used meth or injected drugs, meth-only users had a tripled risk of HCV acquisition (incidence rate ratio [IRR] 3.024, 95% confidence interval [CI] 1.860 to 5.132, P < 0.001), men who only injected drugs had a 13-fold higher risk (IRR 13.167, 95% CI 1.497 to 53.965, P < 0.001), and drug injectors who also used meth had almost a 5-fold higher risk (IRR 4.896, 95% CI 2.401 to 9.644, P < 0.001). HCV acquisition risk did not differ significantly by age, race, or Hispanic ethnicity.
The UCSD team noted that HCV incidence in smaller US groups of HIV-positive MSM ranged from about 0.5 per 100 person-years in the Multicenter AIDS Cohort Study to about 1.5 per 100 in Boston. In the San Diego MSM group, HCV incidence rose from 0.36 per 100 person-years in 2000-2003, to 1.10 per 100 in 2004-2007, to 1.14 per 100 in 2008-2011, and to 1.52 per 100 in 2012-2015 (P = 0.003 for trend). Dividing the cohort by drug use, the researchers plotted a significant increase in HCV incidence among meth-only users (P < 0.001) but not among meth-using drug injectors or men who used no drugs.
To calculate HCV reinfection rates, the UCSD team looked at HIV-positive MSM who had a sustained virologic response (SVR) to anti-HCV therapy between 2006 and 2014 and at least one later HCV RNA test before 2016. They defined reinfection as a positive HCV RNA test following SVR or within 24 weeks of the end of treatment with a genotype switch. This analysis included 43 MSM with a median age of 50 and a median follow-up duration of 1.8 years. Three of those men with a median age of 33 became reinfected during a median 2.7 years of follow-up to yield a reinfection incidence of 2.89 per 100 person-years. In other words, almost 3 of every 100 men who attained SVR became reinfected every year. The researchers note that reported reinfection rates are even higher in Amsterdam (15.2 per 100 person-years), London (9.6 per 100), and Western Europe (7.8 per 100).
The investigators conclude that this large study of HIV-positive MSM recorded high and rising HCV incidence, particularly among men who use methamphetamine or inject drugs. And among men who attain SVR, the reinfection rate is even higher.
1. Chaillon A, Anderson CM, Martin TC, et al. Incidence of hepatitis C among HIV-infected men who have sex with men, 2000-2015. Conference on Retroviruses and Opportunistic Infections (CROI), February 13-16, 2017, Seattle. Abstract 134.
2. Ingiliz P, Martin TC, Rodger A, et al. HCV reinfection incidence and spontaneous clearance rates in HIV-positive men who have sex with men in Western Europe. J Hepatol. 2017;66:282-287. http://www.natap.org/2017/HCV/PIIS0168827816305050.pdf
Reported by Jules Levin
CROI 2017 Feb 14-16 Seattle, WA


Antoine Chaillon, Xiaoying Sun, Edward R Cachay, David Wyles, Christy M Anderson, Thomas CS Martin, Richard S Garfein, Sonia Jain, Sanjay R Mehta, David Looney, Davey M Smith, Susan J Little, Natasha K Martin
WEBCAST: http://www.croiwebcasts.org/console/player/33564?mediaType=slideVideo&
"HCV Reinfection remains a problem particularly amongst MSM....alarmingly high incidence of reinfection in Europe among HIV+ MSM about 5-10 fold that of primary infection, but there is no data from US cohorts....there was about a 3 fold higher incidence rate of primary infection among those who ever used methamphetamine - rates were high but numbers were small for IDUs and meth+IDU.....alarmingly we say an increase in HCV incidence within our cohort from 0.36 per hundred years in 2003 to 1.52 per hundred years in 2015 and this was significant....there was a significant increase in HCV incidence among those who reported ever meth only and there was no significant increase for those who did not report ever use of meth or IDU.....regarding reinfection there were 43 with SVR & 3 reinfections leading to rate of 2.89/100 patient years, average age was young at 33 compared to 50 for primary infection"
published in 2006: Scientists Call For Hepatitis Treatment Of Young Injection Drug Users, Public Health Intervention....http://www.natap.org/2006/HCV/020806_07.htm
Despite that HCV drug regimen prices were drastically reduced to $17k in VA & 35K to NYS medicaid in NYS and other Medicaids the States & their Medicaid Directors, in NY its Jason Helgerson & Gov Cuomo refuse to put money into HCV. At a recent so-called HCV Summit in NYS Jason Helgerson mischaracterized the costs for HCV drugs without anyone from the community or at the event challenging his statements. He stated HCV regimens cost NYS $68k per regimen & overall cost last year was $680 million. He did say actually this was the retail cost but no one at this event understood or recognized what he was doing or challenged him on this. NYS does not pay $68k for a regimen, its more like around $35k, therefore the overall costs were similarly overstated. He does this to throw up a some screen to prevent people from challenging NYS on why they are not funding eradication & screening & linkage to care, because if he can pursued you how costly the drugs are then he & Gov Cuomo hope you will not get past that to ask about funding for screening % linkage to care, because he is telling you the drugs alone are so expensive that we can't even afford that hoping you will sympathize & understand - this prevents even getting to a discussion about funding eradication & screening & linkage. There is no money added to this year's budget for HCV. No progress is being made in NYS towards addressing these needs. Advocacy has gotten nowhere not just in NYS burt federally in Wash DC nor in most states medicaid programs with very lithe progress & very few exceptions. Wash DC, The White House & Congress reused to address HCV throughout the Obama administration despite holding a dog & pony show show every year at the White House, their annual HCV Awareness Day. They actually gave me an award for lifetime achievement in fighting HCV & I almost refused to go but caved in & went, but they do NOT permit public commentary at that meeting, of course on purpose, because they do not want people like me openly criticizing them. The only reason any progress has been made in NYS is because a small group of advocates including me met wit NYS AG Eric Schneiderman's NYC 2 years ago & that led to about 1 year hence Schneiderman's lawsuit which convinced NYS managed medicaid to reduce restrictions. It was only after that NYS DURB removed their restrictions but this act by NYS DURB was useless because it had no impact. Managed medicaid in NYS reduced restrictions only because of the lawsuit, and the DURB act did nothing but tried to look good to the public. Nothing much has happened since, no real attempt by NYS officials towards funding to address HCV in any serious way, only smokescreens like the statements by Helgerson. Public insurers continue to throw up every barrier they can get away with and NYS & other states refuse to fund screening & linkage to care. Two years ago NYS enacted Routine HCV Screenings, the 1st state to do tis, but they did not fund this to one cent. I have had HIV for 35 years & had HCV but was the1st PegInterferon cure back in 2001. Back then we had real load & vocal activists, who were themselves HIV infected, they changed HIV history back in the mid 1990s. Now we have uninfected careerists who have become "advocates" as a career in HIV & HCV, that is the trend now. They pushed PrEP, and work on HCV. Nothing has however changed in Wash DC regarding HCV, White & Congress have not moved one inch to support HCV eradication, screening & linkage. Unfortunately we do not have a real group of HCV-infected activists screaming at the federal or State governments. Instead in NYS we have quiet non confrontation attempts, but in actuality NYS has put no money to this day into HCV, they refuse to discuss an Eradication Plan, they refuse fund needed scale up of screening & linkage to care. All too often those who "speak" for patient needs are receiving grants or want to receive grants from State officials. HCV+ patients are being betrayed. In fact Aging with HIV is a very serious problem in the USA with 80% in NY, SF, Boston & Florida over 45 years old and 50% over 50 & 20% over 60, with many older patients suffering the ravages of aging too soon & too quickly with "accelerated aging" & multicomorbidities & polypharmacy & actual disabilities. But there is no attention or recognition given to this problem. I have devoted myself to this but today's HIV "advocate" prefer to focus only on cure & PrEP. NY City as well puts none of its own money into a needed large scale screening & linkage program. I gave them $2 mill to fund Check Hep C which I designed. Last year they submitted an RFP & received a large grant from the federal govt they now use to fund INSPIRE, an Hcv program in NYC, but NYC itself does not fund ant money towards HCV.



published in 2015 - Incidence of sexually transmitted hepatitis C virus infection in HIV-positive MSM: a systematic review and meta-analysis - HCV in MSM High-Risk Groups - need for targeted hepatitis C prevention and testing campaigns for this group.....http://www.natap.org/2015/HCV/091415_11.htm