Incidence of recently acquired hepatitis C virus infection among HIV‐infected patients in southern Spain

Abstract

Objectives Spain is close to HCV microelimination, so rates of recently acquired HCV infection (RAHC) should decrease. Nowadays, men who have sex with men (MSM) carry the highest risk of HCV acquisition. Our aim was to estimate the incidence of and the factors associated with RAHC, together with reinfection rates, among patients sexually infected by HIV. Methods Primary RAHC infection was diagnosed when anti‐HCV antibody seroconversion was documented. In anti‐HCV positive patients, initially without HCV viraemia, a diagnosis of reinfection was established if plasma HCV RNA was detected. Results All 350 patients tested negative for anti‐HCV at baseline and had at least one follow‐up visit. Among them, there were 16 RAHC cases from 2016 to 2019. RAHC incidence rates [IR (95% confidence interval, CI)] per 100 person‐years were 3.77 (0.5–12.9) in 2016, 1.85 (0.6–4.3) in 2017, 1.49 (0.4–3.8) in 2018 and 1.98 (0.6–4.5) in 2019. Only previous sexually transmitted infections [incidence rate ratio (IRR) = 18.23, 95% CI: 1.93–172.1; P = 0.011], male sex (IRR = 8.33, 95% CI: 1.38–54.15; P = 0.026) and sharing chem‐sex drugs (IRR: 4.93, 95% CI: 1.17–20.76; P = 0.030), were independently associated with RAHC. Four out of 42 (9.5%) patients became reinfected. Conclusions The incidence of RAHC among HIV‐infected patients showed a decrease after 2016, although a lower but steady incidence of residual cases still remains. HCV reinfections showed a similar pattern. New infections were associated with sharing chem‐sex drugs among MSM.

Acute hepatitis C virus infection and direct-acting antiviral drugs: Perfect combination to eliminate the epidemic?

“…11 This is backed by the low percentage of spontaneous clearance. 9 In the PROBE-C cohort, only 11.9% of 464 HIV-positive MSM patients experienced spontaneous resolution of their AHC. 13 Concerning treatment duration, short regimens of 6 and 8 weeks of SOF/LDV have been reported, [14][15][16] although the guidelines continue to recommend the same regimens as for chronic infection and for the same duration, with pangenotypic regimens in the event the genotype is unknown or there is suspicion of infection by more than one genotype [3,11].…”

“…3 Currently, the time to start treatment is not well defined. In our study, we used the criteria prevailing at the time 9 : waiting for at least 4 weeks from the first positive viraemia result, except for those subjects with a high risk of transmission, for whom it is recommended to start treatment immediately after diagnosis. 9 In fact, the latest update of the AASLD and IDSA guidelines also advises immediate treatment ('test and treat').…”

“…7 Accordingly, persons who present these viral kinetics could be primary candidates for early therapeutic strategies, even more so considering the excellent response to DAAs in this setting. 8,9 The aim of this study was to analyse the characteristics and the response to treatment in HIV-positive patients diagnosed with AHC and treated with DAAs.…”

Hepatitis C: Problems to extinction and residual hepatic and extrahepatic lesions after sustained virological response

“…Reinfection following SVR has been documented in several studies in drug users[ 28 ], prisoners[ 29 ], and men who have sex with men (MSM)[ 30 ]. After SVR, the incidence of reinfection is 2 to 6/100 person-years in subjects who inject drugs and 10 to 15/100 person-years in HIV-infected MSM[ 30 - 33 ]. Elevated rates of reinfection may compromise the benefits of treatment.…”

Progress and challenges in the comprehensive management of chronic viral hepatitis: Key ways to achieve the elimination

“…In Spain, a very close to HCV elimination country, homosexual men also carry the highest HCV acquisition risk. The identified main risk factors contributing to new cases of HCV infection in Spain are history of sexually acquired infections [incidence rate ratio (IRR) = 18.2, 95%CI: 1.9-172.1; P = 0.01)], male gender (IRR = 8.3, 95%CI: 1.4-54.2; P = 0.03)] and sharing chem-sex drugs (IRR: 4.9, 95%CI: 1.2-20.8; P = 0.03)[ 92 ]. In the Netherlands, homosexual men also have the highest incidence and the highest HCV reinfection rate despite universal and unrestricted access to DAAs, stressing the need for additional preventive measures[ 93 , 94 ].…”