Abstract: #124 Increasing Primary Incidence of Hepatitis C Among HIV-Infected Men Who Have Sex with Men in San Diego; a Pooled Analysis of Two Large Clinics from 2000-2015 – Antoine Chaillon, et al.
This study retrospectively analyzed data collected between 2000 and 2015 from two of the largest HIV clinics in San Diego. Researchers looked for the incidence of HCV among 2768 men who have sex with men (MSM) who tested positive for HIV, but negative for HCV at baseline.
Conclusion: This research reported a significant increase in HCV incidence over time. They also found that compared to those with no history of meth or injection drug use (IDU), HCV incidence was three times higher among HIV+ MSM who reported meth or IDU use.
Editorial Comments: Similar results were reported in European studies. Although HCV is not transmitted efficiently via sex, we need to arm people with facts about the transmission risk, especially among MSMs.
Lucinda Porter, RN, is a long-time contributor to the HCV Advocate and author of “Free from Hepatitis C” and “Hepatitis C One Step at a Time.” She blogs at www.LucindaPorterRN.com and HepMag.com
Source: Abstract #THU-439 interferon-free therapy is effective and safe for hepatitis C recurrence in liver transplant hepatitis C virus/human immunodeficiency virus coinfected recipients: a case-control study- M.-C. Londoño, et al.
Study Aims and Results: Current studies show interferon-free treatments are successful and safe for monoinfected liver transplant recipients with hepatitis C. There are fewer examples looking at how successful direct acting antivirals are in HCV/HIV co-infected liver transplant recipients. This study focused on looking at the success and side effects of interferon-free treatment in a national cohort of HCV/HIV coinfected participants who had HCV return after transplantation. There were 38 HCV/HIV-coinfected and 133 HCV monoinfected liver transplant participants enrolled in the study. The two groups were fairly similar in gender, age, genotype, viral load, fibrosis stage and the amount of time from transplantation to treatment at 38 and 47 months. All coinfected participants were on HIV treatment; 84% had a RNA viral load of less than 50 copies/ml (undetectable) and a median white blood cell count of 367 cells/uL. For comparison, 1100-1400 white blood cells/ul is the range of someone who is not immunocompromised. The top three direct acting antiviral treatments that were used are as follows: ledipasvir + sofosbuvir ± ribavirin (RBV) (33%), simeprevir+ sofosbuvir ± RBV (31%), daclatasvir + sofosbuvir ± RBV (28%), simeprevir+daclatasvir ± RBV (5%), and AbbVie’s 3D (3%). More than half of each cohort received RBV. The treatment success was also close among the cohorts, with 92% of the coinfected group having a sustained virologic response 12 weeks post treatment (cure), and 96% of the monoinfected group. There were no serious side effects of treatment or differences in success related to genotype and advanced fibrosis.
Conclusion: This study was able to show interferon-free treatments for HIV-positive people who have had hepatitis C return are successful with few side effects. As important, this study showed that the success rates of interferon-free treatment were similar to hepatitis C monoinfected participants.
Editorial Comments: Tackling the issue of treatment for people who receive a liver transplant and have hepatitis C return is crucial to any elimination plan. This is important not only among monoinfected people but those who are coinfected with compromised immune systems. The closer we can get to a treatment that is effective on both cohorts and has fewer side effects, the more likely we are to eliminate hepatitis C and save lives. Most importantly, this study shows that even after liver transplants people can be treated.
Abstract # THU-250 Treatment of “acute” hepatitis C virus in human immunodeficiency virus-infected men with short-course sofosbuvir/ledipasvir—D. S. Fierer et al.
Study Aims and Results
Prior studies to treat acute hepatitis C in people with HIV for 6 weeks with Harvoni (sofosbuvir/ledipsavir) did not achieve favorable results. The aim of this study was to find out if extending the treatment period to 8 weeks improved the cure rates. The inclusion criteria was elevated ALT levels (liver enzymes), documented recent exposure to the hepatitis C virus (HCV antibody and HCV RNA (viral load)) or re-infection after a spontaneous, natural clearance or treatment cure.
Twenty-six HIV positive men who acquired hepatitis C from sexual contact (21 primary infection; 5 re-infection) were enrolled in the study between August 2014 and March 2016. Active drug use was common during this period—mostly methamphetamines. Five men had spontaneous clearance during this period before treatment could be started. The characteristics of the remaining 21 people treated was a median age of 37 yo; 14 (58%) black or Hispanic, twenty (95%) were genotype 1 and one person was a genotype 4.
Treatment was started at a medium of 18 weeks after a diagnosis of acute hepatitis C. Nineteen men received 8 weeks of treatment, one received 6 weeks and one was extended to 12 weeks.
All of the men who were treated were cured. The authors commented that a better understanding of the best timeline to treat acute hepatitis C in people infected with HIV.
A meta-analysis review of acute HCV in people with HIV would be helpful. This will narrow down the optimal timeframe to treat. Still, the cure rates are very encouraging!