Acute hepatitis C in HIV-infected men who have sex with men: An emerging sexually transmitted infection

Cluster of Infectious Diseases, Public Health Service, Amsterdam, The Netherlands.
AIDS (London, England) (Impact Factor: 5.55). 07/2010; 24(12):1799-812. DOI: 10.1097/QAD.0b013e32833c11a5
Source: PubMed


Since 2000 outbreaks of acute hepatitis C virus (HCV) among HIV-positive men who have sex with men (MSM) who denied injecting drug use have been reported from Europe, the United States, Canada and Australia. Given the burden of liver disease, in particular HCV, on the morbidity and mortality in HIV patients in the era of combination antiretroviral therapy, the rapid and significant rise in the incidence of HCV in the HIV-infected MSM population in high-income countries is alarming. This relates to a significant change in the epidemiology of HCV that has occurred, with HCV emerging as a sexually transmitted infection within this population. Work to date suggests that this permucosal HCV transmission results from high-risk sexual and noninjecting drug use behaviours, reopening the discussion on the importance of sexual transmission. Given this occurs almost exclusively in HIV-infected MSM, HIV probably has a critical role mediated either through behavioural and/or biological factors. Finally, the management of acute HCV in HIV infection is complicated by concomitant HIV infection and combination antiretroviral therapy. This review will synthesize the most recent epidemiological, immunological and management issues that have emerged as a result of the epidemic of acute HCV among HIV-infected MSM.

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Available from: Mark Danta, Oct 04, 2015
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    • "Determinants for HCV transmission are recreational drug use, sharing of snorting straws, receptive fisting, ulcerative sexually transmitted infections such as syphilis, group sex, and rectal trauma with bleeding [22,30–32]. There are also a number of potential mechanisms related to HIV that might result in enhanced infectivity of and susceptibility to HCV, including increased HCV loads in serum and semen, and defects in the gastrointestinal immune system [33]. Despite adequate surveillance systems, there is still a significant fraction (up to 45%) of acute HCV infections for which the mode of transmission cannot be identified. "
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    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; 21(8). DOI:10.1016/j.cmi.2015.03.026 · 5.77 Impact Factor
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    • "Sexual transmission of HCV is also common in Persons Living with HIV (PLHIV), particularly in men who have sex with men (MSM) [4]. In several recent outbreaks of HCV infection among HIV infected MSM in Europe, Australia and the US, transmission has been linked to sexual exposure as well as, potentially, to underreported use of non-injecting recreational drugs [4]. These two groups have a high rate of acquisition of HCV: in the first year of injection drug use more than 50% of the subjects acquire HCV and the rate of HCV infection in PLHIV is 1000 higher than that of the general population [2]. "
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    ABSTRACT: In the era of Directly Acting anti HCV Antivirals treatment of hepatitis C is successful in the majority of persons treated. However, treatment of persons with HIV or who inject drugs remains challenging because of special issues: drug–drug interactions with antiretroviral, psychiatric and drug substitution therapies, treatment adherence, impact of treatment on HIV disease course or on risk of bacterial infections. Sofosbuvir induced sustained virologic response in 91% of 23 HIV/HCV coinfected persons treated in combination with ribavirin and pegylated interferon, in 83% of 497 treated in combination with ribavirin and in all 50 patients infected with HCV GT1 treated in combination with ledipasvir and ribavirin. The rates of efficacy in HCV–HIV coinfected were almost the same as those observed in HCV monoinfected suggesting that the efficacy of sofosbuvir is not reduced by HIV coinfection. There are no data on the efficacy of sofosbuvir in injection drugs users. The pangenotypic activity, the high barrier to resistance, the modest potential for drug–drug interactions makes sofosbuvir a reference drug for the treatment of these two special populations.
    Digestive and Liver Disease 11/2014; 46. DOI:10.1016/j.dld.2014.09.027 · 2.96 Impact Factor
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    • "Since the introduction of routine screening of blood products and sterile injection needles the principal cohorts of newly infected patients has changed. The majority of patients presenting as new cases in developed countries now are people who inject drugs and men who have sex with men [3]. Estimates of the annual incidence indicate that three to four million persons are newly infected each year and 350,000 people die annually from HCV related causes [4]. "
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    ABSTRACT: There has long been evidence that hepatitis C can lead to persistent infection in a high proportion of infected individuals, and can progress to chronic liver disease, cirrhosis and hepatocellular carcinoma (HCC). The transition from acute to chronic hepatitis C is usually sub-clinical. Accurate studies of the time course for clearance of acute hepatitis C are difficult to carry out because of the silent onset of the acute disease. The likelihood of spontaneous HCV resolution is associated with several genetic factors, including IL28B inheritance and the DQB1∗0301 allele of the major histocompatibility complex class II. Most data suggest that resolution in the acute phase without progression to chronic disease is not accompanied by significant disease, but minor histological lesions have been observed in anti-HCV positive, HCV RNA negative individuals. The risk of reinfection remains a possibility after clearance of acute hepatitis C. High rates of sexually-transmitted infection are being reported in HIV positive men who have sex with men (MSM). Chronic infection with HCV is the leading cause of end-stage liver disease, hepatocellular carcinoma (HCC) and liver related death in the Western world. The natural history of the chronic disease remains incompletely defined. It is generally a slowly progressive disease characterized by persistent hepatic inflammation, leading to the development of cirrhosis in approximately 10–20% of patients over 20–30 years of HCV infection. However, the published data indicate varying progression rates to cirrhosis. Overall, once cirrhosis has developed there is a 1–5% annual risk of HCC and a 3–6% annual risk of hepatic decompensation. Following an episode of decompensation the risk of death in the following year is between 15% and 20%. The high number of chronically infected individuals, the burden of disease, and the absence of a vaccine indicates that treatment will form part of the disease control but the impact, effectiveness and outcomes of treatment in various groups remain uncertain. Several studies and meta-analysis have concluded that eradication of HCV with antiviral therapy reduces the risk of HCC in patients with chronic hepatitis C, independent of fibrosis stage, but the risk is not eliminated.
    Journal of Hepatology 11/2014; 61(1). DOI:10.1016/j.jhep.2014.07.012 · 11.34 Impact Factor
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