Alarming incidence of hepatitis C virus re-infection after treatment of sexually acquired acute hepatitis C virus infection in HIV-infected MSM

Lambers, Femke A.E.a; Prins, Mariaa,b; Thomas, Xiomarac; Molenkamp, Richardc; Kwa, Davidd; Brinkman, Keese; van der Meer, Jan T.M.b; Schinkel, Jankec; on behalf of the MOSAIC (MSM Observational Study of Acute Infection with hepatitis C) study group

doi: 10.1097/QAD.0b013e32834bac44
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Background: Recent data indicate that seroprevalence of sexually transmitted hepatitis C virus (HCV) infection among MSM is stabilizing in Amsterdam. However, little is known about the incidence of HCV re-infection in MSM who have cleared their HCV infection. We, therefore, studied the incidence of re-infection in HIV-infected MSM who were HCV RNA-negative following HCV treatment of acute primary infection.

Methods: Our study population comprised HIV-infected MSM at two large HIV outpatient clinics in Amsterdam, who were previously diagnosed with a sexually transmitted acute HCV infection and tested HCV RNA-negative at the end of treatment. We defined HCV re-infection as detectable HCV RNA in individuals with an undetectable HCV RNA at the end of treatment accompanied by a switch in HCV genotype or clade. Person–time methods were used to calculate the incidence of re-infection.

Results: Fifty-six persons who became HCV RNA-negative during primary acute HCV treatment were included. Five of the 56 cases relapsed and were not analysed. Eleven persons were re-infected. The incidence of HCV re-infection in this group was 15.2 per 100 person-years (95% confidence interval 8.0–26.5). The cumulative incidence was 33% within 2 years.

Discussion: An alarmingly high incidence of HCV re-infection was found in this group. This high re-infection rate indicates that current prevention measures should be discussed, frequent HCV RNA testing should be continued after successful treatment and, in case of possible relapse, clade typing should be performed to exclude re-infection.

aDepartment of Research, Cluster Infectious Diseases, Public Health Service of Amsterdam

bDepartment of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Center for Infection and Immunity Amsterdam (CINIMA)

cSection of Clinical Virology, Department of Medical Microbiology, Academic Medical Center

dDepartment of Microbiology

eDepartment of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.

Correspondence to Janke Schinkel, Department of Medical Microbiology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Tel: +31 20 566 5621; e-mail: j.schinkel@amc.uva.nl

Received 5 July, 2011

Revised 4 August, 2011

Accepted 5 August, 2011

Data from this study were presented at the CROI 2011, abstract #958.

© 2011 Lippincott Williams & Wilkins, Inc.