Sexual Transmission of HCV and Triple Infection with HBV Predict Spontaneous HCV Clearance in HIV-HCV Coinfected Individuals

By Liz Highleyman

Though traditionally thought to be uncommon, evidence has accumulated over the past few years showing that sexual activity appears to be a significant route of hepatitis C virus (HCV) transmission, especially (though not exclusively) among HIV positive individuals.

It is estimated that about 25% of people initially infected with HCV manage to spontaneously clear the virus without treatment, but the rate and predictors of spontaneous clearance after acute infection are not fully understood.

As reported in the May 5, 2008, advance online edition of the Journal of Hepatology, Nathan Shores of Wake Forest University in Winston-Salem, NC, and an international team of colleagues undertook a study to determine the epidemiological factors that predict the resolution of acute HCV infection without therapy in people with HIV.

This retrospective multivariate analysis included epidemiological data from HIV positive patients with evidence of past or present HCV infection between 2000 and 2007. Data were collected from 1 U.S. and 2 European HIV clinics. A cohort of 769 HIV positive patients referred for treatment with available HCV antibody, HCV RNA, and hepatitis B surface antigen test results were included in the analysis.

The investigators calculated spontaneous HCV clearance rates according to patient race/ethnicity, sex, geographical location, transmission risk factors, and hepatitis B virus (HBV) coinfection.

Results

• Patients who acknowledged a history of injection drug use spontaneously cleared HCV infection significantly less often than those for whom sexual transmission was the presumed route of HCV infection (11.6% vs 21.9%; P=0.004).

• This difference was more pronounced when heterosexual sexual contact as the source of HCV infection was analyzed separately.

• A multivariate analysis identified heterosexual HCV transmission (OR 2.81) and hepatitis B surface antigen carrier status (OR 10.3) as independent factors predicting spontaneous HCV clearance.

• No differences in HCV clearance were observed according to race/ethnicity, sex, or geographical origin.

Conclusion

In summary, the investigators concluded, "sexual transmission, particularly heterosexual, and hepatitis B virus coinfection were the only factors associated with spontaneous HCV clearance in this HIV-infected population."

5/30/08

Reference
NJ Shores, I Maida, V Soriano, and others. Sexual transmission is associated with spontaneous HCV clearance in HIV-infected patients. Journal of Hepatology. May 5, 2008. [Epub ahead of print].