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Increasing incidence of acute hepatitis C in a cohort of individuals diagnosed with primary HIV
Presented by Julie Fox, United Kingdom.
Fox J.1, Thompson E.2, Nastouli E.3, McClure M.2, Muir D.3, Fidler S.2
1Imperial College, Infectious diseases, London, United Kingdom, 2Imperial College, Infectious Diseases, London, United Kingdom, 3St Mary's Hospital, Virology, London, United Kingdom
Objectives: To demonstrate the incidence of acute HCV infection amongst a population of HIV seroconverters.
Methods: 155 HIV-1 MSM identified with Primary HIV infection (PHI) were recruited at St Mary’s Hospital, London between 2000-2006. In-depth sexual behaviour histories and Hepatitis C testing were performed at regular intervals.
Results: One individual was HIV/HCV co-infected at baseline. During follow up, 12 individuals seroconverted to HCV. Of these 12, the median time from acquiring HIV to acquiring HCV was 17 months (range 5 to 41). Diagnoses of acute HCV occurred as follows: 1 in 2003, 1 in 2004, 6 in 2005 and 4 in 2006. 3/12 had abnormal LFTS at acute HCV diagnosis and 4 were symptomatic. None had concomitant STI at time of HCV diagnosis but 5 had acquired a STI since PHI. All individuals reported unprotected sex with individuals assumed to be HIV positive at acute HCV diagnosis and all transmissions occurred within the UK. Recreational drugs had been consumed by all individuals in the preceding 3-months and 2 had shared sex toys with casual partners. Retrospective sampling showed that all individuals were HCV RNA negative at HIV seroconversion. 10/12 viruses were genotype 1a and 2/12 genotype 4d. During HCV seroconversion 4 patients had a rise in HIV pVL (median increase 4.1 Log10 copies/ml, range 2.64- 4.7Log10). In those with elevated LFTs at HCV diagnosis 2/3 had a pVL rise compared to 2/9 with no increase.
Conclusions: We propose that in high risk individuals such as those diagnosed with PHI, those reporting high risk sexual behaviour or those with a new STI in the context of HIV, be tested more regularly for Hepatitis C.
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