Incident Hepatitis C Virus Infection in Men Who Have Sex With Men: A Prospective Cohort Analysis, 1984-2011
ABSTRACT Background. Prospective characterization of the hepatitis C virus (HCV) transmission in both HIV-infected and -uninfected men who have sex with men (MSM) over the entire HIV epidemic has not been comprehensively conducted. Methods. To determine the trends in and risk factors associated with incident HCV in MSM since 1984, 5,310 HCV antibody (anti-HCV) negative MSM in the Multicenter AIDS Cohort Study were prospectively followed from 1984-2011 for anti-HCV seroconversion. Results. During 55,343 person-years (PYs) of follow-up there were 115 incident HCV infections (incidence rate 2.08/1000 PYs) scattered throughout the study period. In a multivariable analysis with time-varying covariates, older age (incidence rate ratio (IRR) 1.40/10 years, P<0.001), enrollment in the later (2001-2003) recruitment period (IRR 3.80, P=0.001), HIV infection (IRR 5.98, P<0.001), drinking>13 alcoholic drinks/week (IRR 1.68, P<0.001), hepatitis B surface antigen positivity (IRR 1.68, P<0.001), syphilis (IRR 2.95, P<0.001), and unprotected receptive anal intercourse with >1 male partner (IRR 3.37, P<0.001) were independently associated with incident HCV. Among HIV-infected subjects, every 100 cell/mm(3) increase in CD4 count was associated with a 7% (P=0.002) decrease in the HCV incidence rate up to a CD4 count of 500 cells/mm(3); whereas, there was no association with HAART. Conclusions. The spread of HCV among both HIV-infected and -uninfected MSMs in the United States has been ongoing since the beginning of the HIV epidemic. In HIV-infected men with <500 CD4+ T-cells, the HCV incidence rate was inversely proportional to CD4 T-cell count.
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- "Currently, the epidemic appears to be levelling off in The Netherlands . Outside Europe (the USA and Japan), this seems not to be the case, with recent reported incidence rates being between 0.21 per 100 PYFU and 2.49 per 100 PFYU  . The acute HCV re-infection rate is even higher, with reported rates of 7.8 and 15.2 per 100 PYFU  . "
ABSTRACT: Acute hepatitis C virus (AHCV) infections are frequently seen worldwide in certain risk groups with an annual incidence rate varying between 0.08% and 66%. Although this incidence is substantial, a delayed diagnosis during chronic infection is most often made in the absence of clinical symptoms in the acute phase of the infection. Current used methods to diagnose AHCV are IgG antibody seroconversion and repeated HCV RNA measurements though no definite diagnostic test is currently available. Progress in the field of adaptive and innate immune responses has aided to both advancements in the field of HCV vaccine development and a more basic understanding of viral persistence. The rapid changes in the treatment of chronic HCV will affect therapeutic regimens in AHCV in the coming years leading to shorter treatment courses and pegylated interferon-free modalities. This review gives an overview of the current knowledge and uncertainties together with some future perspectives on acute HCV epidemiology, virology, immunology and treatment. Copyright © 2015. Published by Elsevier Ltd.Clinical Microbiology and Infection 04/2015; DOI:10.1016/j.cmi.2015.03.026 · 5.20 Impact Factor
Article: Update on HIV/HCV coinfection[Show abstract] [Hide abstract]
ABSTRACT: Liver disease is currently one of the leading causes of hospitalization and death in HIV-positive individuals. Coinfection with the hepatitis C virus (HCV) is a major contributor to this trend. Besides hepatic damage, which is enhanced in the presence of HIV-associated immunosuppression, HCV may contribute to disease in coinfected individuals by potentiating immune activation and chronic inflammation, which ultimately account for an increased risk of cardiovascular events, kidney disease, and cancers in this population. Fortunately, hepatitis C therapeutics has entered a revolutionary era in which we hope that most patients treated with the new oral direct-acting antivirals (DAA) will be cured. However, many challenges preclude envisioning a prompt elimination of HCV from the coinfected population. Issues that should be addressed include the following: (1) rising incidence of acute hepatitis C in men who have sex with men, and expansion/recrudescence of injection drug use in some settings/regions; (2) adverse drug interactions between antiretrovirals and DAA; and (3) high cost of DAA, which may lead many to defer or fail to access appropriate therapy.Current HIV/AIDS Reports 07/2013; 10(3). DOI:10.1007/s11904-013-0169-5
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ABSTRACT: Hepatitis C virus (HCV) infection is the most common chronic bloodborne infection in the United States, with approximately 3.2 million Americans being chronically infected. Rates of HCV-related end-stage liver disease and its associated morbidity and mortality have yet to peak, so there is a pressing need for more effective and tolerable HCV treatment. HCV genotypes 1, 4, 5, and 6 are considered difficult to treat, and the need for improved therapies is especially great for persons infected with these genotypes. Current therapy for genotype 1 HCV infection includes triple therapy with pegylated interferon, ribavirin, and a NS3/4A protease inhibitor. Sustained virologic response (SVR) rates with triple therapy range from 42% to 75%, a vast improvement over pegylated interferon and ribavirin therapy alone. However, response rates remain suboptimal, and triple therapy is associated with significant adverse effects and is only indicated for genotype 1 HCV infection. HCV drug development is proceeding at a rapid pace to meet this need. Novel direct acting antiviral agents in several classes, including new NS3/4A serine protease inhibitors, NS5A replication complex inhibitors, NS5B polymerase inhibitors, interferon lambda, and microRNAs, are in varying stages of development. These new therapeutic agents promise SVR rates of up to 100% with durations as short as 12 weeks and, often, fewer adverse effects. New drug development in HCV is proceeding at an unprecedented pace. Novel agents promise higher SVR rates, shorter duration of therapy, and fewer adverse effects than have been possible with HCV therapy to date.Hepatic Medicine: Evidence and Research 08/2013; 5:53-61. DOI:10.2147/HMER.S48545