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

A Special Author Introduction
AIDS

ISSN: 0269-9370 • Frequency: 18/year • Subscribe Now • Journal Website

By Femke lambers

Since the late nineties a new epidemic of hepatitis C virus infection (HCV) has emerged among HIV-infected men who have sex with men (MSM) in urban regions worldwide. Until recently there was no evidence for sexual transmission of HCV, which is primarily spread through blood-blood-contact. However, studies into the risk-factors for HCV transmission among HIV-infected MSM indicate that in this specific population HCV is transmitted mainly through high risk sexual contact.
In Amsterdam, where this HCV epidemic has been well studied, the results of these studies have led to the development of primary and secondary prevention strategies. These include a prevention messaging campaign regarding HCV transmission risks, and increase of HCV screening and treatment among MSM. Although a recent survey at the STD outpatient clinic of the public health service in Amsterdam suggested that the incidence of HCV infections is stabilizing among MSM who have not been infected before, it was not clear how many men are being reinfected with HCV. As demonstrated in studies among injecting drug users, reinfection with HCV after clearance of the virus, spontaneously or after treatment, occurs frequently when risk behaviour is continued. Although having been infected with HCV does not provide immunity to a new infection, the occurrence of partial protective immunity is still a topic of discussion.
In the current study among MSM visiting two HIV outpatient clinics in Amsterdam, we calculated the incidence of HCV reinfection after clearance through treatment. The incidence was 15.2/100 person years, which is remarkably high and alarming. It first of all indicates that there is need for more targeted prevention messages and continuous HCV risk counselling by HIV physicians in order to change risk behaviour. Interestingly, most patients in this study-population were reinfected  with a different genotype compared to their previous infection. This may be an indication for the existence of genotype-specific immunity and may be relevant when studying the dynamics of this epidemic. To optimize the prevention of future HCV (re)infections in this population, it is therefore essential to continue and combine research on risk behaviour and clinical, virological and immunological aspects of  HCV infection.

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