Abstract
Background
Using direct acting antivirals (DAA) for recently acquired hepatitis C virus (RAHCV-) infections, particularly in HIV-positive men having sex with men (MSM), dramatically reduced hepatitis C incidence. However, implementation into clinical practice is challenging. The aim of this study was to analyse spontaneous clearance (SC) rates of RAHCV and to identify predictors of SC.
Methods
The PROBE-C study is an observational European cohort on RAH CV-infections in HIV-positive MSM. Between 2007 and 2017, RAHCV-infections were documented with at least 12 months of follow-up. Fisher's exact, chi-square and Mann-Whitney U test were used for statistical analysis.
Results
464 RAHCV-infections were documented. 457/464 (98%) cases were male, median age was 41 years (IQR 38-46). Main risk groups for HCV-transmission were MSM (98.9%). Most participants were infected with HCV-genotype (GT) 1 (78.3%). Median baseline HCV-RNA was 230,000 (135,000-474,432) IU/mL, median CD4
+-T cell count was 574 (547-604) cells/µL. 92% of all cases received combination antiretroviral therapy with 91% showing suppressed HIV-RNA (<200 copies/mL). Median maximum alanine aminotransferase was 445 (402-522) U/L.SC of RAHCV-infection occurred in 55/464 (11.9%) cases. A >2log decline in HCV-RNA four weeks after diagnosis of RAHCV infection was the strongest predictor of SC (p < 0.001, sensitivity 96.4%, specificity 97.5%, PPV 8 4.1%, NPV 99.5%).
Conclusions
SC of RAHCV in HIV-positive MSM is only found in 11.9% of cases and a <2log drop in HCV-RNA at week four after diagnosis should prompt for early DAA-based treatment. However, immediate DAA treatment for RAHCV-infection may also be favoured in patients with ongoing transmission risk behaviour.
