STUDY Abstract: THU-429 Strong increase of acute HCV infections in HIV-negative men having sex with men – L. Cotte, et. al.
Study Aims and Results: There is strong evidence of HCV transmission in HIV-positive men having sex with men (MSM), especially those engaging in at-risk sexual practices such as chemsex (use of stimulants to enhance sexual experience), or other practices that may cause mucosal trauma (tissue damage). This French study sought to assess the risk in HIV-negative MSM.
Data were collected from 86 MSM (63 HIV+, 23 HIV-) between 2014 and 2017, identifying 92 acute HCV infections (71 first infections, 21 reinfections). The HCV risk factors included IV drug use (34%), nasal drug use (31%), sex party (66%), fisting (22%), and any drug or sexual risk (83%).
Conclusions: There was a significant increase in the number of cases of sexually transmitted HCV infections in MSM, both in HIV-positive and in HIV-negative.
Editorial Comments: These findings underscore the importance of education and harm reduction, screening of people at risk for HCV and other infectious diseases, and increasing efforts to enable access to care and HCV treatment. By doing so, we keep progressing toward the goal of eliminating viral hepatitis, as well as to help those affected by hep B and C.
STUDY Abstract: THU-412 Among 1945–1965 birth cohort patients with at least one additional hepatitis C virus risk factor, one in eight were positive for HCV antibody: an underserved safety-net population experience – G. Hirode, et al.
Study Aims and Results: This study conducted in an urban hospital (Oakland, CA) evaluated a pilot program that integrated HCV screening into an outpatient endoscopy unit. Using the U.S. Preventative Services Task Force’s HCV screening guidelines, this study screened adults undergoing outpatient endoscopy from 2015 to 2017. None of the 1,752 adults evaluated were previously tested for HCV, of which 67% were found eligible.
Conclusions: Among those who completed HCV testing, the prevalence of HCV antibody-positive results was 3.4%. The highest occurrence of positive HCV-antibody results occurred in baby boomers (born 1945–1965) who had other risk factors (HIV positive, hepatitis B virus positive, history of intravenous drug use, previously incarcerated, or blood transfusion pre-1992). HCV prevalence was 12.5% in baby boomers with other HCV risk factors; the prevalence was nearly 27% in U.S.-born baby boomers with other HCV risk factors.
Editorial Comments: The part of this study that I find most noteworthy is the high number of adults who had not been previously screened for HCV. This shows the value of creating safety-net programs in order to identify people who meet HCV screening criteria, and might not otherwise be screened.
STUDY Abstract: FRI-368 Long-term immunological and clinical impact of HCV eradication with direct-acting antivirals in patients with HCV-associated cryoglobulinemia vasculitis – M. Bonacci, et al.
Study Aims and Results: The goal of this Spanish study was to evaluate the long-term impact of direct-acting antiviral (DAAs) in patients with HCV-related symptomatic or asymptomatic cryoglobulinemia (cryo). This study enrolled 94 patients, of which 50 had symptomatic and 44 had asymptomatic cryo.
Conclusions: Although this study found that patients who were treated for HCV experienced significant improvements in both clinical and immunological response, cryo persisted in more than 20% of patients for 2 years after HCV elimination. Cryo relapses also occurred. No patients with asymptomatic cryo developed symptomatic cryo during follow-up. Researchers recommended a longer monitoring period for these patients.
Editorial Comments: Although this is a small study, I think it is valuable. Approximately 40% to 60% of patients with chronic HCV have circulating cryoglobulins, symptomatic cryo (vasculitis) is only observed in about 10% of HCV patients. Two features of this study stand out:
No one with asymptomatic cryo developed symptomatic cryo during follow-up. This adds more evidence to the long-term benefits of HCV treatment.
Perhaps this study offers insight into why some patients continue to have medical problems after HCV treatment. I hope we see more research on this subject.
STUDY Abstract: THU-418 Lymphomas incidence in HIV/HCV coinfected versus HIV monoinfected patients over twenty-one years of follow up (1993–2014) – A.M. de Cea, et al.
Study Aims and Results: This Spanish study evaluated the incidence of Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) in people coinfected with HIV/HCV, and compared them with the general population. Researchers looked at 11 years of data (1993–2014) collected from 2,318 people (37% of them HIV/HCV coinfected). More than half died from lymphoma, with no significant differences observed between HIV monoinfected and HIV/HCV coinfected. The survival rate was better for HL than NHL (86.6% after 2 years of diagnosis vs 32.5%).
Conclusions: The incidence of lymphoma (Hodgkin and non-Hodgkin) was up to 15 times higher among people with HIV monoinfection and HIV/HCV coinfection compared with the general population. The researchers hypothesize that HCV treatment will have an important role in reducing risk of lymphoma.
Editorial Comments: Since there was no significant differences between HIV monoinfected and HIV/HCV coinfected, I am not sure how the researcher came to the conclusion that HCV treatment will have an important role in reducing risk of lymphoma. Intuitively, it makes sense, but we need more data.
STUDY Abstract: THU-399 Incidence and prevalence of extrahepatic manifestations of HCV – H. El-Serag, et al.
Study Aims and Results: Chronic HCV infection is associated with problems outside of the liver. The medical terms for these are extrahepatic manifestations (EHMs). This retrospective study evaluated data from national U.S. Veterans Affairs database from 1999 through 2016. They compared 244,655 HCV-positive subjects to 244,655 subjects without HCV.
Researchers found that prior to treatment, EHMs were higher in patients with HCV compared to those without HCV. This included cryoglobulinemia, glomerulonephritis, porphyria cutanea tarda, and lichen planus. People with untreated HCV were four times more likely to have cryoglobulinemia. Non-Hodgkin’s lymphoma and diabetes were not more prevalent.
Conclusions: There is a clear association between HCV and risk of extrahepatic manifestations. These researchers recommend HCV treatment in order to reduce EHM risk.
Editorial Comments: I am curious about the finding that non-Hodgkin’s lymphoma and diabetes were not more prevalent among people with untreated HCV. This isn’t consistent with earlier studies. For more about lymphoma, see the next abstract (THU-418). The abstract after that (FRI-368) discusses more about HCV-associated cryoglobulinemia.
STUDY Abstract: THU-100 Hepatitis C patients with HIV co-infection demonstrate unique liver-related complications and health behaviors compared to HCV mono-infected patients – M. Lu, et al.
Study Aims and Results: The purpose of this study was to investigate the impact of HIV on clinical characteristics and mental health in hepatitis C-positive patients.
This study gathered data on 14,545 hepatitis C-positive (HCV) people, of which 584 (4%) were co-infected with HIV. The coinfected individuals were significantly younger and more likely to be male, African American, low-income, and publicly insured than those who had HCV monoinfection. The HIV/HCV individuals were less likely to see a liver specialist, receive HCV treatment, and had more comorbidities, fibrosis/cirrhosis, hepatocellular carcinoma (liver cancer), and increased mortality. Among 5008 survey respondents (4885 HCV and 123 HIV/HCV), coinfected individuals were more likely to report substance use and sex with multiple partners.
Conclusions: People who are coinfected with HIV/HCV are more at risk of multiple types of health problems than those with HCV monoinfection.
Editorial Comments: People with HIV/HCV coinfection face serious medical complications and may be falling through cracks in the health care system. This large study identifies key issues that need to be addressed in the public and private health care sectors
Abstract: THU-099 Lowering the upper limit of serum alanine aminotransferase levels may detect significant liver disease in the elderly – H. Schmilovitz-Weiss, et al.
Study Aims and Results: A common first blood test used to assess liver injury is measuring serum alanine aminotransferase (ALT), which is a liver enzyme. Some experts believe that the current normal ranges for ALT may be too high. If so, one may have liver injury despite the test result being technically normal.
In this study, researchers compared normal ALT results between previous normal ranges and newly suggested ranges of 49,634 individuals aged ≥ 65 years. The standard normal ranges were 42–45 IU/l for men and 26–34 IU/l for women. The newly suggested normal ranges were 15–42 IU/L for men and 10–26 IU/L for women.
Using the standard ranges, researchers found that people whose ALTs were on the high side of the normal range had higher rates of chronic liver disease. They identified 2022 people with chronic liver disease although they had normal ALT levels; 366 had cirrhosis.
Conclusions: These researchers concluded that lowering the current normal ranges of serum ALT might help to identify significant liver disease in the elderly.
Editorial Comments: If your liver enzymes consistently fall in the upper range of normal, talk to your healthcare provider. Ask if you need to be referred to a liver specialist.
STUDY Abstract: THU-421 Screening for Neurocognitive Dysfunction in Non-Cirrhotic Chronic Hepatitis C Infection in an Irish Academic Unit – D. Ferguson, et al.
Study Aims and Results: This study investigated the prevalence of neurocognitive dysfunction in Irish HCV patients. Of 431 HCV-positive people, 48% had cognitive dysfunction.
Conclusions: This study’s investigators stressed the importance of screening for cognitive dysfunction in HCV patients, particularly the often overlooked non-cirrhotic patients.
Editorial Comments: This study is still in progress with future plans to release results on the potential reversibility of this neurocognitive dysfunction using exercise intervention or viral eradication.
STUDY Abstract: THU-395 Lower Risk of Multiple Sclerosis in Patients with Chronic Hepatitis – J. Söderholm, et al.
Study Aims and Results: The aim of the present study was to investigate the risk for multiple sclerosis (MS) in HCV patients. Data were collected from a nationwide population-based register from 2001–2013 in Sweden. The prevalence of MS was lower in those with HCV (0.087% or 37/42,522 subjects) compared with those without HCV (0.27% or 544/202,694 subjects).
Conclusions: This large study found that people with HCV were at a lower risk of developing MS compared with those without the virus.
Editorial Comments: It is nice to read some good news! I would love to see this study duplicated in the U.S.
STUDY Abstract: THU-113 Effectiveness of Hepatitis C Virus Screening Laws in United States: Evidence from Paid Claims Data from 2010 to 2016 – D. Mehta, et al.
Study Aims and Results: This study evaluated the effectiveness of HCV screening policies of 5 U.S. states (NY, CA, CT, MA, CO) beginning in 2014. The aim was to assess the U.S. progress in meeting the World Health Organization’s (WHO) goal of screening 90% of the world’s population for HCV infection by 2030. Researchers gathered data from a large claims database, from 2010-2016.
Compared to 2010, annual screening rates were increased by nearly 20% after 2014. In the states that passed screening laws, screening rates were increased by an additional 6%. Medicare enrollments, females, and the presence of comorbidities were associated with an increased likelihood of screening.
Projections of screening rates suggest that NY and 4 other states without screening laws were on track to reach the WHO target by 2030; 8 additional states are projected to reach the WHO target by 2040; 29 states would not attain this target by 2050.
Conclusions: Over 90% of states in the U.S. are still not on track to reach the WHO target by 2030.
Editorial Comments: As bad as this sounds, the projections may be even worse if we don’t solve the opioid crisis.
STUDY Abstract: THU-090 The Covert “C”; Prevalence: Risk Factors and Management of Hepatitis C in Psychiatric In-Patients – J. Ramachandran, et al.
Study Aims and Results: In the by-gone era of treating HCV patients with interferon, people with mental illness were underserved because of interferon’s high profile of psychiatric side effects. Now with the availability of direct-acting antivirals (DAAs), this Australian study of patients who were hospitalized with mental illness assessed: (1) HCV seroprevalence, (2) HCV risk factors, and (3) experience of treatment and follow-up. Of 241 patients (70% male with median age 43 years), the HCV risk factors were intravenous drug use (28%), exposure to custodial stay (20%), tattooing (63%), blood transfusion or organ transplantation (10%), sex workers (16%) and indigenous descent (8%). The prevalence of HCV antibody was 10%.
HCV RNA was negative in 11 of 25 patients with positive antibody, of which 5 had prior treatment and 6 had spontaneous clearance. In the remaining 14 patients with detectable HCV RNA, five were treated with DAAs. The remaining 9 untreated patients were difficult to engage with despite efforts by care teams.
Conclusions: These researchers concluded that psychiatric inpatients should be considered a high-risk population for HCV and routine screening should be considered. However, treating this patient population was challenging due to difficulties engaging.
Editorial Comments: This study had problems enrolling subjects, and thus is small. However, I agree that we should consider HCV screening for this population. I’d love to see a peer model approach, where peers with HCV talk about their HCV treatment experiences.