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HCV antibody decline associated with RNA clearance in MSM with HIV
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Among HIV-positive men who have sex with men, a decline in hepatitis C virus antibodies after acute HCV infection was associated with HCV-RNA clearance, according to researchers from the Academic Medical Center in Amsterdam.
“The seroconversion window in this population was comparable to the seroconversion window reported among HIV-uninfected subjects,” the researchers wrote in Clinical Infectious Diseases. “Seroreversion was very common following successful antiviral treatment, and after an initial decrease in [HCV antibody] levels following SVR, levels increased following reinfection to levels reached during primary infection (or higher).”
The study included 63 MSM with HIV who were diagnosed with acute HCV infection. The researchers determined the interval between the last negative and first positive HCV-RNA test by testing previous blood samples retrospectively. They tested the patients for HCV antibodies every 6 months for the first year after infection and annually thereafter. They estimated date of seroreversion using the first negative HCV antibody test and the preceding sample.
The median time from infection to seroconversion was 74 days. HCV antibody levels peaked upon seroconversion, with a median sample-to-cut-off (S/CO) ratio of 89.4. There were 36 individuals who experienced HCV clearance: five spontaneously and 31 after treatment. Among these, the HCV antibody levels decreased significantly.
Eight of the patients who achieved an SVR experienced full seroreversion, and those who spontaneously cleared the infection experienced partial seroreversion. The cumulative incidence of seroreversion was 37% within 3 years of seroconversion (95% CI, 18-66) or 51% within 3 years of reaching SVR.
There were 21 reinfections among 18 of the patients during the follow-up period: 13 after SVR, three before SVR was reached, four after spontaneous clearance, and one without intermittent negativity. The peak HCV antibody levels were significantly higher during reinfection compared with primary infection, with a median S/CO ratio of 119.4.
“Although the antibody assay used is not a quantitative assay, a clear association existed between [HCV antibody levels] and viremia within subjects following acute HCV infection,” the researchers wrote. “Monitoring antibody dynamics following SVR could thus be a useful and inexpensive alternative and additional tool for evaluation and diagnosis of HCV reinfection in the HIV-infected MSM population.”
Disclosure: The researchers report no relevant financial disclosures.
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