Back HCV Prevention HIV11: Sexually Transmitted HCV Rising among HIV+ Gay Men in Europe, but More Are Getting Treated

HIV11: Sexually Transmitted HCV Rising among HIV+ Gay Men in Europe, but More Are Getting Treated

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Hepatitis C virus (HCV) infection rates continue to rise among HIV positive people in Europe, with the highest incidence among injection drug users and men who have sex with men, researchers reported at the 11th International Congress on Drug Therapy in HIV Infection last month in Glasgow. Another study, however, found that HIV/HCV coinfected people are now more likely to receive hepatitis C treatment.

Over the past decade several outbreaks of presumed sexually transmitted HCV infection have been reported among HIV positive gay and bisexual men, first in cities in the U.K. and Europe, followed by Australia and the U.S. Studies have not seen a similar phenomenon among HIV negative men who have sex with men (MSM), despite similar sex- and drug-related behavior.

Ole Kirk from the University of Copenhagen and fellow investigators conducted a study to determine the incidence of acute hepatitis C -- indicating recent infection -- within the large EuroSIDA cohort, and to explore regional differences throughout Europe and between different HIV transmission risk groups.

The analysis included EuroSIDA participants who were HCV antibody negative at baseline (January 1, 2002, or entry into the cohort) and had at least 2 available HCV antibody test results. HCV seroconversion was defined as change from a negative to a positive HCV antibody test within the observation period.

Results

  • A total of 150 HCV seroconversions occurred among 4295 EuroSIDA participants during 18,928 person years (PY) of follow-up.
  • The overall incidence was 0.79 acute infections per 100 PY.
  • 95 of these seroconverters (63%) were gay/bisexual men.
  • The incidence of HCV seroconversion increased from 0.47 per 100 PY in 2002 to 2.34 per 100 PY in 2010, with an overall incidence of 0.79 acute infections for the entire period.
  • In a multivariate analysis, injection drug use was associated with a higher incidence rate ratio (IRR) -- 4.59, or more than 4-fold higher -- than men having sex with men.
  • Southern and Eastern Europe both had higher incidence than Western Europe (IRR 1.98 and 2.41, respectively).
  • Later calendar years were also associated with a higher incidence (IRR 1.29, or 29% increase every 2 years).

"The incidence of acute HCV within EuroSIDA increased over time," the researchers concluded. "Although the incidence of seroconversion was 54% higher in MSM than in heterosexuals, injection drug users had the highest incidence of HCV seroconversion."

"Rising incidences can be found in all European regions highlighting the need for increased prevention efforts in all European countries," they advised -- a recommendation that could also be appropriate for the U.S.

Hepatitis C Treatment

A second study presented at the conference found that more HIV people in the same cohort are taking advantage hepatitis C treatment, although some may be waiting for better options.

Daniel Grint from Royal Free Hospital in London and fellow EuroSIDA investigators assessed the frequency of hepatitis C treatment -- using at least pegylated interferon (Pegasys or PegIntron) plus ribavirin, and possibly the new direct-acting antivirals boceprevir (Victrelis) or Telaprevir (Incivek or Incivo) ---among HIV/HCV coinfected study participants. They also estimated the effect of treatment on all-cause mortality and liver-related death.

Up to 30% of HIV positive patients in Europe who are tested for HCV are seropositive, the researchers noted as background. "All coinfected patients with chronic HCV and F2 [moderate] fibrosis should be considered for HCV therapy given their increased risk of death from liver disease," they wrote.

This prospective observational analysis included 1947 EuroSIDA participants who tested positive for both HCV antibodies and HCV RNA. Just over 40% had difficult-to-treat HCV genotype 1. About three-quarters had a history of injection drug use.

Results

  • Overall, 456 HIV/HCV coinfected patients (23%) received hepatitis C treatment during a median follow-up period of 107 months.
  • The likelihood of hepatitis C treatment rose from 0.29 per 100 PY in 1998 to 5.26 per 100 PY in 2007, fell to 3.73 per 100 PY in 2009, and stabilized at 4.70 in 2010.
  • During the early upswing, treatment uptake increased by approximately 25% per year, followed by a 12% annual decline.
  • Considerable regional differences were observed in treatment uptake; Northern Europe had the highest rate in 2010, though rates in other regions had peaked and fallen previously.
  • Factors that significantly predicted treatment included CD4 T-cell count greater than 350 cell/mm3 (IRR 1.75), HIV RNA < 500 copies/mL (IRR 1.58), and HCV genotype 3 (IRR 1.55 vs genotype 1).
  • A total of 355 deaths from all causes and 95 liver-related deaths occurred during follow-up.
  • In a multivariate model, hepatitis C treatment was not significantly associated with all-cause mortality (IRR 0.81) or liver-related death (IRR 1.0).

"The incidence of treatment for HCV among coinfected patients increased from 1998 until 2007 and was common in those with higher CD4 cell counts and lower HIV RNA, consistent with HCV treatment guidelines," the researchers concluded. "HCV treatment was not associated with all-cause or liver-related death in this population."

Grint suggested that possible reasons for the recent stabilization in treatment uptake could be that most eligible patients have already been treated, or that people without advanced liver disease may be waiting for new and better therapies currently in development, including interferon-free all-oral regimens.

12/14/12

References

J Rockstroh, D Grint, C Boesecke, O Kirk, et al. Increases in acute hepatitis C (HCV) incidence across Europe: which regions and patient groups are affected? 11th International Congress on Drug Therapy in HIV Infection (HIV11). Glasgow, November 11-15, 2012. Abstract O242.

D Grint, L Peters, M Vogel, et al. Temporal changes and regional differences in treatment uptake of hepatitis C therapy in EuroSIDA. 11th International Congress on Drug Therapy in HIV Infection (HIV11). Glasgow, November 11-15, 2012. Abstract O243.