July 12, 2013
According to the results of a study by Dr. Thomas Martin of Chelsea and Westminster Hospital, London, United Kingdom, approximately 25 percent of HIV-infected individuals who are cured of hepatitis C virus (HCV) infection acquired a second and sometimes a third HCV infection within 24 months of the initial cure. Martin noted that liver disease was one of the leading non-AIDS causes of death among HIV-infected individuals. Also, earlier studies showed that HIV coinfection reduced spontaneous clearance of HCV infection, reduced the rate of successful treatment, and could lead to cirrhosis three times faster.
Martin and colleagues analyzed reinfection rates in 191 HIV patients with primary HCV infection treated at the Chelsea and Westminster Hospital. The researchers defined reinfection as a new positive HCV RNA polymerase chain reaction 24 weeks or more after HCV treatment, spontaneous clearance of the virus, or the emergence of HCV with a different genotype in a 24-month period. The rate of reinfection was 7.8 per 100 patient-years among this group of participants. The HCV infection was cleared from the 17 of the 32 reinfected patients after treatment or by spontaneous remission. Eight of the 17 patients acquired a third HCV infection, resulting in a rate of 23.2 per 100 patient-years. The second and third reinfections cleared spontaneously in 20 percent of patients and, with treatment, complete viral clearance occurred in 80 percent.
Martin noted that researchers found no evidence of protective immunity from the first HCV infection and the participants remained at high risk for reinfection. The researchers concluded that gay men needed counseling to understand the risk of reinfection and the importance of prevention. Implications for future monitoring indicated that in cases where a patient had been cured of previous HCV infection, a clinician needed to use an RNA viral load test to diagnose reinfection.
This study was presented at the Seventh International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention, June 30-July 3, 2013, in Kuala Lumpur, Malaysia.