Sexual transmission is associated with spontaneous HCV clearance in HIV-infected patients

Shores, Nathan J.; Maida, Ivana; Soriano, Vincent; Núñez, Marina

doi:10.1016/j.jhep.2008.04.010

Cited by 37 publications

(35 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Reinfection following spontaneous clearance of sexually acquired HCV in an HIV positive MSM has recently been described [12] and there is further preliminary data to suggest that rates of re-infection in this setting may be high [14], presumably due to repeated exposures and lack of modification of ongoing high-risk behaviours. Again, no further details on risk factor behaviour in the homosexual group were provided in the study by Shores et al [30] so any conclusions must be speculative, but the perceived 'low rate of spontaneous clearance' in the homosexually acquired cases may in fact represent instead a high rate of HCV re-exposure through ongoing high-risk sexual behaviour, similar to that observed in IDUs.…”

Section: See Article Pages 323-328mentioning

confidence: 95%

The role of re-infection in determining rates of spontaneous clearance after hepatitis C exposure

Matthews

Grebely

Dore

2008

Journal of Hepatology

View full text Add to dashboard Cite

In this issue of the Journal, Shores and colleagues report that sexual transmission may be associated with higher rates of spontaneous hepatitis C virus (HCV) clearance in HIV infected patients. In an international cross-sectional study of 769 HIV/HCV coinfected patients (positive for HIV and HCV antibodies), HCV RNA status was assessed at an undetermined timepoint following initial HCV infection. Evidence of spontaneous HCV clearance (as determined by a single negative HCV RNA test in the absence of any HCV-specific treatment) was found in 13% of patients overall, a lower rate than the 20-30% rate generally found in HCV monoinfected populations [1]. In multivariate analysis, the only factors predicting negative HCV RNA were HBV coinfection and the risk factor for HIV and/or HCV transmission. Rates of spontaneous clearance were 11.6% in those presumed to be infected through injecting drug use (IDU) and 21.9% in those infected through sexual contact. Further, although the number of patients reporting homosexual contact as a risk factor was small, these patients had a similar rate of negative HCV RNA as the IDU group (13.5% vs 11.6%). Differences in spontaneous clearance rates appeared to be driven by the group with heterosexual contact as the major risk factor for viral transmission (26% of whom were HCV RNA negative). In the multivariate model, heterosexual transmission was independently associated with negative HCV RNA with an odds ratio of 2.81 (95% CI 1.55-5.09, p = 0.001). The authors declare that the reasons for this are unclear but postulate that the observed differences may be linked to smaller viral inoculums or differing genital immune responses in the group infected through heterosexual contact. However, a more likely explanation for their findings would appear to be differential risk of re-exposure and subsequent HCV re-infection across the study groups.HCV re-infection following spontaneous HCV clearance has been demonstrated in both chimpanzees [2][3][4][5][6][7] and humans [8][9][10][11][12]. In chimpanzees with clearance of primary infection, HCV rechallenge with both homologous or heterologous virus can lead to HCV re-infection, despite the presence of persistent humoral immunity [2][3][4][5][6][7]. There is often rapid control of viral replication, accelerated clearance of viraemia and greater likelihood of spontaneous resolution of secondary infection, suggestive of partial protective immunity [4,6,7]. However, some chimpanzees rechallenged with HCV develop viral persistence [2]. A number of studies have now demonstrated that control of re-infection is likely associated with HCV-specific T-cell responses [3,5,13].In human studies, similar findings have been observed. HCV re-infection following spontaneous HCV clearance has been described in children receiving multiple transfusions for thalassemia [8] and among IDU [10-12] and MSM [14] who were subsequently re-exposed to the virus. One study of acute infection and re-infection following spontaneous HCV clearance 0168-8278/$34.

show abstract

Section: See Article Pages 323-328mentioning

confidence: 95%

The role of re-infection in determining rates of spontaneous clearance after hepatitis C exposure

Matthews

Grebely

Dore

2008

Journal of Hepatology

View full text Add to dashboard Cite

show abstract

“…HIV-infected patients exposed to HCV are less likely to clear the acute infection (odds ratio, 0.46) (123). This scenario seems to be especially relevant to transmission via IVDU (110). On the other hand, coinfected individuals are more likely to transmit HCV.…”

Section: Epidemiologymentioning

confidence: 99%

Coinfection with Hepatitis C Virus and Human Immunodeficiency Virus: Virological, Immunological, and Clinical Outcomes

Rotman

Liang

2009

J Virol

117

111

View full text Add to dashboard Cite

Infection with hepatitis C virus (HCV) is estimated to affect 2% of the world population (90) and is a leading cause of liver-related morbidity and mortality. Human immunodeficiency virus (HIV) is also a very important global public health problem, infecting about 33 million people worldwide (129). As the transmission routes are shared by both infections, coinfection is not uncommon. In this review, we discuss the magnitude of the problem, the effect of infection with one virus on the transmission and natural history of the other, and the treatment issues unique to coinfected patients. EPIDEMIOLOGYThe reported prevalence of HIV/HCV coinfection varies significantly among studies. Although HIV and HCV are both transmitted through parenteral, sexual, and vertical exposure, they differ in the transmission efficiencies of these routes. Thus, the risk factors of the population under study directly influence the prevalence in that particular population. Parenteral exposure modes such as intravenous drug use (IVDU) or multiple transfusions have been consistently found to be the most important risk factors for coinfection (121). In HIV-positive patients with a history of IVDU, the rate of HCV infection is reported to be 82 to 93% (61,76,113). On the other hand, sexual transmission of HCV is relatively inefficient, and the rate of coinfection among HIV-infected patients with a sexual risk factor is less than 10% (61). Men who have sex with men do not seem to have an overall-increased risk for coinfection (21,61,121), although epidemics of acute HCV have been described for HIV-infected men who have sex with men with high-risk behaviors (33). The overall burden of coinfection is estimated at 4 to 5 million people worldwide (2).Apart from the shared routes of transmission, infection with HIV, when present in either HCV-transmitting or HCV-exposed patients, can have a direct effect on the risk of transmission of HCV. HIV-infected patients exposed to HCV are less likely to clear the acute infection (odds ratio, 0.46) (123). This scenario seems to be especially relevant to transmission via IVDU (110). On the other hand, coinfected individuals are more likely to transmit HCV. The rate of vertical transmission of HCV is increased about threefold for coinfected mothers (95) compared to that for HCV-monoinfected ones; this effect may be limited to women with low HCV RNA levels (Ͻ10 6 IU/ml) (69). Percutaneous exposure of health care workers to blood from coinfected patients was also shown to increase the risk of acquiring HCV (35). Although coinfected individuals have been shown to have a higher prevalence of HCV RNA in cervicovaginal secretions (85) and semen (25), sexual transmission of HCV is still rare, even to partners of coinfected patients (68). EFFECT OF HIV/HCV COINFECTION ON THE NATURAL HISTORY OF HCVCoinfection with HIV has a significant impact on the life cycle of HCV and on the natural history of HCV infection. A retrospective study of stored sera from multitransfused hemophiliac patients (42) and a similar study of IV...

show abstract

“…It has been postulated that HCV is sexually transmitted via low-density viral particles and the prolonged exposure in the absence of other risk factors is not an independent risk factor. 9,21,22 The risk of acquiring HCV through casual or ongoing sexual contact without other risk factors is extremely low but not zero and without genital abrasion or bleeding. 2,23 In Australia, about 211 700 persons were HCV chronic carriers by the end of 2008.…”

Section: Discussionmentioning

confidence: 99%

“…25 Risk of sexual transmission is increasing in older people, although heterosexual HCV transmission is associated with increased rates of spontaneous clearance. 9,21 Continual vigilance for sexual transmission as a source of HCV infection is necessary for the 30-40% of HCV-infected patients without parenteral sources of infection.…”

Section: Discussionmentioning

confidence: 99%

Acute hepatitis C infection with evidence of heterosexual transmission

Nguyen

Sheppeard

Douglas

et al. 2010

Journal of Clinical Virology

View full text Add to dashboard Cite

Sexual transmission is associated with spontaneous HCV clearance in HIV-infected patients

Cited by 37 publications

References 34 publications

The role of re-infection in determining rates of spontaneous clearance after hepatitis C exposure

The role of re-infection in determining rates of spontaneous clearance after hepatitis C exposure

Coinfection with Hepatitis C Virus and Human Immunodeficiency Virus: Virological, Immunological, and Clinical Outcomes

Acute hepatitis C infection with evidence of heterosexual transmission

Contact Info

Product

Resources

About