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HCV reinfection remains high in MSM with HIV regardless of treatment

Long-term surveillance among men who have sex with men with HIV after clearance of hepatitis C may be warranted as reinfection rates remain high and continue to occur more than 11 years after clearance regardless of treatment, according to a study presented at CROI.

“This high reinfection rate in New York tells us that we have not done a good job of treating all our HIV-infected patients with hepatitis C despite the availability in NYC of direct-acting antivirals since 2013,” Daniel S. Fierer, MD, from the Icahn School of Medicine at Mount Sinai in New York, said during his presentation.

According to Fierer, previous studies dating back to 2011 showed that reinfection rates after interferon treatment ranged from 3% to 15% among MSM in Europe compared with an average primary incidence rate of 0.5%.

The current study comprised 304 patients who cleared HCV with pegylated interferon or direct-acting antiviral therapy. Thirty-seven of those patients became reinfected for an incidence rate of 4.4 per 100 person-years (95% CI, 3.1-6) during a median of 1.9 years (range, 1.3-3.6 years).

“This rate is at least 7 times higher than the primary infection rate in NYC, similar to patterns seen in Europe,” Fierer noted.

Of the 33 patients with subsequent HCV clearance after reinfection, another 6 were reinfected again for an incidence of 8.7 per 100 person-years (95% CI, 3.5-18.1) during a median of 1.1 years (range, 0.6-2.5 years).

Fierer and colleagues observed no significant difference in reinfection rates or time to reinfection among patients treated with PEG-IFN, DAAs, or those who achieved spontaneous clearance.

“We can't treat our way out of the epidemic without changes,” Fierer said. “What we need is to treat early to prevent ongoing HCV infection, restrictions to DAA availability need to be eliminated, and disparities need to be addressed. Prevention is essential. To start, we need to identify those who are at high risk of reinfection.” – by Talitha Bennett

Reference: Carollo JR, et al. Abstract 84LB. Presented at: Conference on Retroviruses and Opportunistic Infections; March 4-7, 2019; Seattle.

Disclosure: Fierer reports receiving grants and stocks or stock options from Gilead Sciences.