Only a quarter of HIV-positive individuals diagnosed with acute hepatitis C infection are accepting anti-hepatitis C therapy, according to data from one of the UK’s leading sexual health clinics presented to the Third International Workshop on HIV and Hepatitis Coinfection in Paris on June 7th. The investigators, from the Mortimer Market Centre at University College Hospital, London, also reported that they have detected cases of sexual transmission of hepatitis C infection in HIV-negative gay men. Doctors in Brighton reported seeing cases of the infection in HIV-negative gay men at a conference earlier this year.
Between 1999 and April 2006, a total of 108 acute hepatitis C infections had been diagnosed in HIV-positive gay men attending the Mortimer Market Clinic. Most of these infections (60%) were diagnosed due to abnormal liver function, but 28% were detected due to screening or contact tracing, and 12% because of the presence of symptoms.
Most men are thought to have acquired hepatitis C sexually. Only 8% reported a lifetime history of injecting drug use. 18% reported having a sexual partner who was infected with hepatitis C virus and 36% had been diagnosed with a sexually transmitted infection in the previous year. This compared to between 18 - 20% of HIV-positive men without hepatitis C seen at the clinic.
The men had a median age of 38 years, and had been diagnosed with HIV a median of four years previously. Hepatitis C was, however, diagnosed in 17% of men within a year of their HIV diagnosis and in 40% of men within five years after their HIV was first diagnosed.
The hardest to treat of all hepatitis C genotypes – genotype 1 – was present in 69% of the men, with 19% having genotype 4 infection, which is also difficult to treat.
Hepatitis C infection cleared spontaneously in 10% of the men. However, rebound or reinfection occurred in six men.
Only 25 men, (24%) accepted anti-hepatitis C therapy and 60% of these achieved a sustained virological response. The investigators reported that many patients were declining treatment because they hoped better, more tolerable therapy would become available in the future. The best results were seen when, as per the guidelines of the British HIV Association, treatment with pegylated-interferon and ribavirin was used. Only 33% of patients who received pegylated-interferon alone achieved a sustained virological response.
Turner J et al. Acute hepatitis C: presentation and outcome of early treatment. Third International Workshop of HIV and Hepatitis Coinfection, Paris, abstract 26, 2007.