HCV reinfection prevalence rises among MSM as acute cases decline
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LONDON — Although the annual incidence of acute hepatitis C virus has decreased over the past 10 years in Frankfurt, Germany, the prevalence of HCV genotype 4 increased in men who have sex with men, according to research.
“Despite the broad availability of direct acting antivirals, ongoing transmission of HCV, as well as a persistent epidemic of HCV infections, has been especially observed in high interest groups such as HIV-positive men who have sex with men,” Christiana Graf, of the University Hospital Frankfurt department of internal medicine, said at the International Liver Congress. “While the incidence of acute hepatitis C has been observed to increase in the United States over the past decade, it seemed to decline in the European countries and is still largely unknown in many other parts of the world.”
In a prospective, observational study, Graf and colleagues analyzed clinical and epidemiological parameters of 161 patients (87% HIV positive, 90% MSM) diagnosed with acute HCV between 2009 and 2019 in Frankfurt, Germany, to characterize HCV transmission among MSMs. At the time of diagnosis, NS5B population-based sequencing was used to determine HCV genotype (GT) and phylogenetics.
While HCV GT1 was most common genotype in the first 8 years of the study (58%-100%), its prevalence decreased to 30% in 2018. Conversely, the proportion of patients with HCV GT4d increased from 2013 to 2019 (0%-40%). Researchers also reported more cases of HCV GT3a in 2018 and 2019, but only individual cases of HCV GT1b/GT2 between 2009 and 2014.
While HCV genotypes were equally distributed among non-MSM patients (36% GT1a, 21% GT1b or GT3a and 16% GT2), the most common among MSM patients were GT1a (82%) and GT4d (16%). Further, phylogenic analyses showed close relation of sequencing patterns in HCV GT1a and GT4d strains among MSM patients.
Comparison of HCV GT or NS5B sequences revealed HCV reinfection occurred in 15% of patients with the incidence rate for a first HCV infection among MSM patients declining between 2017 and 2019 (3.6/1,000 person-years) compared with the direct acting antiviral era (2013-2017: 6.8/1,000 person-years) and the interferon era (2008-2013: 10.1/1,000 person-years). In contrast, incidence of HCV reinfection among MSM patients increased over time (1.9/100 person-years to 2.8/100 person-years).
“We observed an overall decline of acute HCV cases in Frankfurt, Germany. All classes proved to be MSM-specific, and I think that we showed that there seems to be distinct and specific transmission networks and classes among MSM,” Graf concluded. “We observed an increase in reinfection incidence. Thus, post-treatment surveillance, rapid diagnostics and prioritizing dosing is crucial in order to achieve elimination.”
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Graf C, et al. Abstract OS001. Presented at: International Liver Congress; June 22-26, 2022; London (hybrid meeting).
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