[955] ACUTE HCV IN A COHORT OF HIV-POSITIVE HOMOSEXUAL MEN IN A LONDON CLINIC

2nd International AIDS Society Conference on HIV Pathogenesis and Treatment

Paris, France - July 13 - 16, 2003

[TITLE:] ACUTE HCV IN A COHORT OF HIV-POSITIVE HOMOSEXUAL MEN IN A LONDON CLINIC – RISK FACTORS AND OUTCOMES

[AUTHOR(S):] S Bhagani¹, K Aizen¹, S Fletcher¹, M Danta², G Dusheiko² and MA Johnson¹
¹Department of HIV Medicine; and ²Hepatology Unit, Royal Free Hospital, London, UK

IAS Conf HIV Pathog Treat 2003 Jul 13-16;2nd: Abstract No. 955
Antiviral Therapy 2003; 8(Suppl. 1):S453

[ABSTRACT:] Background: There has been a recent increase in the incidence of HCV amongst HIV-positive homosexual men in London. Sexual transmission of HCV is considered low risk. We determined the risk factors for transmission, virological outcomes and response to treatment in a cohort of HIV-positive men with recently acquired HCV infection.

Methods: Acute HCV was defined as a documented negative HCV-antibody test (EIA-3) in the 6 months prior to a positive antibody test and/or a positive HCV-RNA by RT-PCR (TMA, Versant) accompanied by a rise in hepatic transaminases. HCV genotypes were determined by Lipa (Genprobe). Risk factors for HCV acquisition and STDs within the previous 6 months were documented. All patients were offered early treatment with Peg-IFN alpha-2b and ribavirin.

Results: Between October 2002 and January 2003, twenty cases of acute HCV were identified (mean age 30.5 years, median CD4 576 cells/µl). 11 patients were on HAART. Unprotected sexual intercourse was a universal risk factor, with group sex and fisting in 15/20 (75%). 10/20 (50%) had a documented STD including 2 patients with acute HIV seroconversion. 14/20 (70%) had shared cocaine vials and 2 had injected drugs. Genotype 1 infection was noted in 9/20, whilst one patient each had genotypes 3 and 4 infections. 9 patients could not be genotyped. 8/20 (40%) spontaneously became HCV-RNA negative within 3 months, without treatment. 6 patients have started treatment with Peg-IFN/ribavirin. Early virological responses will be presented.

Conclusions: In this cohort of men, unprotected intercourse and sexual practices like fisting and group sex, and sharing cocaine vials are major risk factors for transmission of HCV. These preliminary results suggest a high rate of spontaneous viral clearance although longer follow-up is required. We continue to monitor virological response to early treatment.

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