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CROI 2008: Rapid Liver Fibrosis Progression in HIV Positive Men with Acute HCV Infection

In recent years there have been reports of several outbreaks of apparently sexually transmitted acute hepatitis C among mostly HIV positive men who have sex with men (MSM) in European cities and Australia. These cases are notable because the patients were known to already be infected with HIV when they acquired HCV (typically HCV is acquired first).

Several studies have shown that HIV-HCV coinfected individuals with chronic hepatitis C tend to experience more rapid liver fibrosis progression. But little is known about the effect of HIV on liver disease in people with acute HCV infection.

At the 2007 Conference on Retroviruses and Opportunistic Infections (CROI) last February, Daniel Fierer and colleagues from Mt. Sinai School of Medicine in New York City presented early data from a prospective study of HIV positive MSM with acute HCV infection, defined as the first 6 months after HCV infection. The researchers considered a combination of 3 criteria as indicators of acute hepatitis C: recent seroconversion to HCV antibody positive status, marked elevations in serum alanine aminotransferase (ALT) level, and wide fluctuations in HCV viral load.

Study participants underwent liver biopsy within 4 months of the first-noted ALT elevation. Fibrosis was staged using the Scheuer system, on a scale of 0 to 4. Fibrosis progression rate (FPR) was calculated by dividing the fibrosis stage by the interval between the dates of the recent ALT elevation and the biopsy.

As previously reported, among the first 5 enrolled patients, 4 already had moderate portal fibrosis during acute hepatitis C. At this year’s CROI, taking place this week in Boston, the researchers presented a poster describing further data from more study participants.


  • Of the 11 patients who underwent liver biopsy, 9 did so within 4.5 months of detection of ALT elevation, and 2 within 16 months.
  • Despite the short duration of HCV infection, 9 of the 11 (82%) had stage 2 fibrosis and 1 had stage 1 fibrosis.
  • The mean FPR in these 11 patients was 4.5 (± 3.3) units per year.
  • No causes of liver damage other than acute HCV infection were identified.
  • In the analysis of risk factors for HCV acquisition, only 4 patients reported even a single episode of intravenous drug use.
  • However, non-injection drug use and high-risk sexual behavior were common.
  • 7 reported club drug (including methamphetamine) use and 10 reported unprotected anal intercourse with multiple partners.

Based on these findings, the researchers concluded, “Acute HCV infection of MSM with underlying HIV infection resulted in early and rapid progression of liver fibrosis, with FPR rates far in excess of other settings of HCV infection.”

“Many of these HIV-infected men with acute HCV used non-injection drugs and had unprotected sex with multiple partners,” they continued. “Some appear to have become HCV-infected via sexual activity.”

The investigators recommended that, “More intensive prevention and screening strategies for acute HCV in MSM are needed,” and “further research is needed to identify the disease processes leading to this highly accelerated liver injury.”

Mt Sinai School of Medicine, New York, NY.



D Fierer, A Uriel, D Carriero, and others. An Emerging Syndrome of Rapid Liver Fibrosis in HIV-infected Men with Acute HCV Infection. 15th Conference on Retroviruses and Opportunistic Infections. Boston, MA. February 3-6, 2008. Abstract 1050.

Accelerated Liver Disease Progression in HIV-HCV Coinfected Patients May Be Due to Increased Liver Inflammation

Although results have not been not entirely consistent, several studies have shown that HIV-HCV coinfected patients tend to experience more rapid liver disease progression than HIV negative people with hepatitis C alone. A study reported in the January 11, 2008 issue of AIDS suggests a possible mechanism underlying accelerated liver disease progression in coinfected individuals.


Attitudes of Health Professionals toward Caring for People with Hepatitis C

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Eltrombopag Raises Platelet Counts, Enabling Initiation of Interferon-based Therapy for Hepatitis C

Thrombocytopenia, or low platelet count, can lead to easy bruising and prolonged bleeding. People with advanced liver fibrosis or cirrhosis often develop thrombocytopenia, and it can also be a side effect of interferon alfa therapy. For this reason, patients with pre-existing thrombocytopenia are typically advised not to use interferon-based therapy for hepatitis C, even though they may be the ones who need treatment most urgently.

Antiviral Activity of Interferon beta-1a with or without Ribavirin in Asian Patients with Chronic Hepatitis C

Treatment with pegylated interferon alpha-2a (Pegasys) or pegylated interferon alpha -2b (PegIntron) plus ribavirin is the current standard of care for treatment of chronic hepatitis C virus (HCV) infection. This regimen produces a sustained virological response (SVR) in approximately 50%-60% of patients.

Acute Hepatitis C Infection and Spontaneous Viral Clearance in Adults and Children

Studies of acute hepatitis C virus (HCV) infection can be challenging, since a majority of infected people do not experience symptoms, and thus do not present for care and HCV testing.

Asian Patients Appear to Respond Better than Whites to Pegylated Interferon Plus Ribavirin for Hepatitis C

As reported in the July 19, 2007 advance online edition of the American Journal of Gastroenterology, researchers with the Canadian Pegasys Expanded Access Group conducted a study to determine whether Asian race/ethnicity is an independent predictor of response to antiviral therapy in patients with hepatitis C.

Adherence to Hepatitis C Treatment among Recovering Heroin Users on Methadone Maintenance

As reported in the September 2007 issue of the European Journal of Gastroenterology and Hepatology, Diana Sylvestre, MD, from the University of California at San Francisco and colleagues evaluated the impact of mental health issues, active drug use, and other potential adherence barriers in a real-world sample of recovering drug users on methadone maintenance therapy.

Anadys to Halt Development of Investigational Hepatitis C Drug ANA975

Anadys Pharmaceuticals announced last week that it will discontinue development of its investigational anti-HCV drug candidate, ANA975, a toll-like receptor 7 agonist.Anadys was developing the agent in collaboration with Novartis. The decision comes in the wake of disappointing data from toxicology studies in animals. Toll-like receptor agents can cause excessive immune stimulation, leading to a range of side effects.