Most HIV/HCV coinfected patients do not clear HCV spontaneously

BOSTON — The vast majority of patients with HIV do not spontaneously clear acute hepatitis C virus, according to research presented at the Conference on Retroviruses and Opportunistic Infections.

Because most acute HCV cases also progress to chronic disease, the data highlight a need to treat high-risk patients early to prevent transmission, the researchers said.

Researcher Christoph Boesecke, MD, an infectious diseases specialist at Bonn University Hospital in Germany, and colleagues conducted an observational study of HIV-positive patients with acute HCV coinfection. Between 2007 and 2017, they gathered data on 464 acute HCV episodes among coinfected patients in Austria, Denmark, France, Germany, Spain and the United Kingdom. Patients were followed for at least 12 months.

According to the researchers, 99% of acute HCV transmissions occurred via men who have sex with men (MSM), and 1% of transmissions occurred through IV drug use, the researchers said. Nearly all patients — 92% — received ART, and 91% had HIV RNA suppressed to less than 200 copies/mL at baseline.

Just 55 cases of acute HCV (11.8%) resolved spontaneously, the researchers said. Treatment with direct-acting antivirals (DAAs) was started within 48 weeks of acute HCV diagnosis in 325 patients (69.9%), and the rate of sustained virologic response was 75.7%.

Results also showed that 51 patients (11%) were reinfected with HCV, and 85 patients (18.3%) developed chronic HCV infection. Previous studies have found that most patients with acute HCV — 85% to 90% in some studies — develop chronic HCV. That highlights the importance of early DAA treatment, in particular among MSM, Boesecke and colleagues said.

“Therefore, treatment initiation needs to be considered early on to prevent onward transmission to sex partners,” they wrote. “As a result, DAA drug labels, as well as clinical guidelines, need to be amended to allow usage of DAA during the acute phase of HCV infection in a high-risk population.” – by Joe Green

References:

Blackard JT, et al. Hepatology. 2008;doi:10.1002/hep.21902.

Boesecke C, et al. Abstract 129. Presented at: Conference on Retroviruses and Opportunistic Infections; March 4-7, 2018; Boston.

Disclosure: Boesecke reports working as a consultant and serving on speakers bureaus for AbbVie, Gilead Sciences, Janssen, Merck and ViiV Healthcare.