Multiple hepatitis C virus (HCV) reinfections in HIV‐positive men who have sex with men: no influence of HCV genotype switch or interleukin‐28B genotype on spontaneous clearance

Abstract

ObjectivesThe incidence of sexually transmitted hepatitis C virus (HCV) reinfection is on the rise in HIV-infected men who have sex with men (MSM). Data on natural history of acute hepatitis C and possible factors associated with spontaneous clearance are limited. The aim of this study was to analyse the outcome of HCV reinfections in HIV-positive MSM. MethodsA retrospective analysis was carried out on patients with more than one sexually acquired HCV infection who were diagnosed at four major German HIV and hepatitis care centres. Reinfection was defined by genotype or phylogenetic clade switch, detectable HCV RNA after a sustained virological response (SVR) or after spontaneous clearance (SC). ResultsIn total, 48 HIV-positive MSM were identified with HCV reinfection, among them 11 with a third episode and one patient with four episodes. At the first episode, 43 and five patients had an SVR and SC, respectively. The second episode was accompanied by a genotype switch in 29 patients (60%). Whereas 30 and nine patients showed an SVR and SC, respectively, eight patients developed chronic hepatitis. Neither HCV genotype switch nor interleukin-28B genotype was associated with SC. However, SC rates at the second episode were higher for patients with SC at the first episode compared with patients without SC (60 vs. 14%, respectively; P = 0.03). Two patients with SC at the first episode were reinfected with the same genotype. ConclusionsMultiple reinfections in HIV-infected MSM do occur, with or without genotype switch, and with prior SC of previous episodes. In this large case series, except for SC at the first episode, no factor was of value in clinical decision-making for early therapeutic intervention in acute HCV reinfection.

High-Resolution Hepatitis C Virus Subtyping Using NS5B Deep Sequencing and Phylogeny, an Alternative to Current Methods

“…In addition, coinfection with two or more HCV strains of different genotypes or subtypes is a common finding in some high-risk groups. Researchers who performed several studies in persons who inject drugs (PWID) and among men who have sex with men (MSM) have reported the simultaneous presence of two or more HCV subtypes in 25% to 39% of incident infections (16)(17)(18)(19). Taken together, the findings of the subtype-specific response to different classes of DAA and of the frequency of multiple infections among groups with the highest incidence and prevalence of HCV infection make accurate HCV subtyping, including detection of mixed infections, an essential tool to optimize current and future treatment regimens.…”

HCV epidemiology in high-risk groups and the risk of reinfection

“…The lack of protective immunity HCV reinfection after spontaneous clearance of the virus has been observed in chimpanzees [101,102] and in humans [7,[103][104][105][106][107][108][109][110][111][112][113][114]. As reviewed elsewhere [115], some of these studies have demonstrated evidence of an augmented HCV-specific immune response following reinfection compared to after primary infection, suggesting that some immunological control may develop after repeated exposure to the virus.…”

HCV reinfection incidence and spontaneous clearance rates in HIV-positive men who have sex with men in Western Europe

“…Yet despite these outcomes the epidemic has continued unabated (5, 10). In the presence of maintained risk behavior, HCV reinfections have been described in PWID and MSM who either cleared their initial infection spontaneously or were successfully treated with interferon-based therapies (17)(18)(19)(20). In a recent meta-analysis of 61 studies, the five-year risk of HCV reinfection in HIV infected MSM was as high as 15% and higher than in studies on PWID (21).…”