Acute Hepatitis C in Patients with HIV

Abstract

Almost 10 years ago clinicians started to note the first cases of an outbreak of acute hepatitis C (AHC) infections among human immunodeficiency virus- (HIV-) positive men who have sex with men (MSM) in Europe, soon followed by similar reports from the United States and Australia. In the absence of randomized controlled treatment trials in AHC, coinfection expert consensus recommendations based upon published data from uncontrolled clinical and cohort studies give guidance on best clinical management. Pegylated interferon in combination with weight-adapted ribavirin is still recommended as the treatment of choice for all HCV genotypes. For patients developing a rapid virologic response, treatment duration of 24 weeks is recommended. If antiviral therapy was initiated within 24 weeks after diagnosis, high sustained virologic response rates of 60 to 80% have been observed. Prevention and screening efforts along with early anti-HCV therapy have to be intensified to allow for control of viral dissemination as the current epidemic of AHC particularly among MSM is still ongoing.

Scaling up epidemics of acute hepatitis C and syphilis in HIV‐infected men who have sex with men in Spain

“…Thus, a high level of suspicion is needed to make the diagnosis. Moderate liver enzymes elevations in MSM who acknowledge recent unsafe sexual risk practices should prone to exclude acute hepatitis C. In contrast to HIV‐negative individuals, in whom acute HCV infection shows spontaneous clearance in up to 30% of cases , progression to chronicity seems to be more common in HIV‐infected persons , as it occurred in our series. Early antiviral therapy is recommended in patients who do not reach a significant decay in serum HCV‐RNA 4 weeks after diagnosis or who still have detectable HCV‐RNA 12 weeks after first diagnosis.…”

“…As in our series, most individuals experiencing acute hepatitis C are asymptomatic or complain only mild unspecific symptoms after 1–2 months of contagion . Thus, a high level of suspicion is needed to make the diagnosis.…”

“…In HIV-infected men, syphilis may be associated with an increased viral load and transient CD4 declines (32,33), which may result in a higher risk of HIV transmission, even in patients on antiretroviral therapy. In the subset of them co-infected with HCV both HIV immunodeficiency and genital ulcerative diseases have been found to facilitate the sexual transmission of HCV (13,15,26,29). The very high rates of syphilis we are reporting among HIV-positive MSM in Madrid, with around 20% annual incidence, represents a unique opportunity for a rapid spreading of HCV once introduced in this community.…”

“…During the last decade, outbreaks of acute hepatitis C in HIV‐positive MSM have increasingly been reported at large cities in Western Europe, North America and Australia . Casual sex with multiple partners, anal sex, fisting, use of psychotropic drugs and coincident genital ulcerative diseases seems to favour HCV contagion in this setting .…”

Alterations of the NK cell pool in HIV/HCV co-infection

“…Due to similar transmission routes of infection a relevant proportion of human immunodeficiency virus (HIV)-positive patients is co-infected with the hepatitis C virus (HCV)[1]. HIV/HCV co-infection is associated with a faster progression to liver fibrosis and cirrhosis, resulting in higher mortality compared to HCV mono-infected individuals[2–8].…”