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HCV Reinfection Rate 40% in Netherlands HIV+ MSM 5 Years After Clearance
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AIDS 2020: 23rd International AIDS Conference Virtual, July 6-10, 2020
Mark Mascolini
One quarter of HIV-positive Netherlands men who have sex with men (MSM) enrolled in an observational cohort study became reinfected with HCV within 2.5 years of clearing the hepatitis virus [1]. Five years after initial clearance, 40% of MSM in this group had HCV infection again. Sex behavior strongly predicted HCV reinfection.
Sexually transmitted HCV infection has been on the rise in many MSM populations since 2000 [2,3]. Although sex-related risks for primary HCV infection in MSM are well known, few prospective studies have explored risk of reinfection. Researchers working with the Public Health Service of Amsterdam and other centers undertook this study to map HCV reinfection incidence in MSM after spontaneous clearance or successful therapy and to ascertain clinical and behavioral risk factors for reinfection.
The analysis involved participants in the observational MOSAIC cohort conducted in six HIV outpatient clinics in Amsterdam, Rotterdam, and Utrecht. For this study researchers selected HIV-positive MSM with acute HCV infection in 2002-2017 who completed at least one risk behavior questionnaire after HCV clearance. They defined reinfection as a positive HCV RNA after spontaneous clearance or successful therapy and set the date of reinfection as the midpoint between the last negative and first positive HCV RNA.
Of the 122 MSM studied, 28 (23%) became reinfected with HCV by the end of follow-up. Median age stood at 43.2 in reinfected men and 45.7 in men not reinfected. About 84% overall were Dutch. Median year of HCV cure was 2011 in reinfected men and 2013 in the others. Total person-years of follow-up stood at 65.7 in reinfected MSM and 229.7 in men not reinfected. Median follow-up time measured 1.6 years in reinfected men and 1.2 years in men not reinfected.
The 28 reinfected men had 34 reinfections for an overall incidence of 11.5 per 100 person-years . Incidence of first reinfection was 8.0 per 100 person-years, and incidence of second, third, or fourth reinfection was 38.3 per 100 person-years. Cumulative incidence of first reinfection 2.5 years since HCV clearance of the previous infection was 25% (95% confidence interval [CI] 17 to 36). Cumulative incidence 5 years after initial clearance came to 40% (95% CI 28 to 54). Median time to reinfection measured 1.3 years (interquartile range 0.6 to 2.7).
Univariable Bayesian survival regression identified 7 predictors of HCV reinfection at the following hazard ratios (HR) (and 95% CI):
-- Nadir CD4 count below 200: HR 2.22 (1.05 to 4.81)
-- Current CD4 count below 500: HR 3.60 (1.73 to 7.64)
-- Receptive condomless anal intercourse: HR 4.27 (1.86 to 9.78)
-- Sharing sex toys HR 4.91 (2.27 to 10.31)
-- Group sex: HR 2.80 (1.33 to 5.98)
-- Anal rinsing before sex: HR 2.47 (1.14 to 5.43)
-- 10 or more casual sex partners (vs 0): HR 2.81 (1.26 to 6.50)
The researchers conclude that HCV reinfection in these men with HIV is very high and strongly linked to risky sexual behavior. They suggest that the risk factors they identified could help professionals develop risk reduction interventions and could help clinicians single out men at high risk for reinfection who need more frequent HCV RNA testing. This study was just published in Clinical Infectious Diseases [4].
Compared with these Netherlands results, HCV reinfection rates have been lower in recent reports of other HIV-positive MSM. Among 272 HIV/HCV-positive people studied in Australia, only 5 (1.8%), all MSM, became reinfected for an overall incidence of 1.05 per 100 person-years [5]. In Spain’s Madrid region, 12 of 177 MSM with HIV (6.8%) became reinfected for an incidence of 5.93 per 100 person-years [6].
References
1. Newsum AM, Matser A, Schinkel J, et al. Incidence of HCV reinfection among HIV-positive MSM and its association with sexual risk behavior: A longitudinal analysis. AIDS 2020: 23rd International AIDS Conference Virtual. July 6-10, 2020. Abstract PDB0306.
2. van Santen DK, van der Helm JJ, Del Amo J, et al. Lack of decline in hepatitis C virus incidence among HIV-positive men who have sex with men during 1990-2014. J Hepatol. 2017;67:255-262. doi: 10.1016/j.jhep.2017.03.038.
3. Ghisla V, Scherrer AU, Nicca D,, Braun DL, Fehr JS. Incidence of hepatitis C in HIV positive and negative men who have sex with men 2000-2016: a systematic review and meta-analysis. Infection. 2017;45:309-321. doi: 10.1007/s15010-016-0975-y.
4. Newsum AM, Matser A, Schinkel J, et al. Incidence of HCV reinfection among HIV-positive MSM and its association with sexual risk behavior: a longitudinal analysis. Clin Infect Dis. 2020 May 27:ciaa645. doi: 10.1093/cid/ciaa645.
5. Hosseini-Hooshyar S, Martinello M, Yee J, et al. Low hepatitis C virus reinfection rate despite ongoing risk following universal access to direct-acting antiviral therapy among people living with HIV. AIDS. 2020;34:1347-1358. doi: 10.1097/QAD.0000000000002562.
6. Berenguer J, Gil-Martin A, Jarrin I, et al. Reinfection by hepatitis C virus following effective all-oral direct-acting antiviral drug therapy in HIV/hepatitis C virus coinfected individuals. AIDS. 2019;33:685-689. doi: 10.1097/QAD.0000000000002103.
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