Hepatitis C Twice for HIV+ Gay Men
posted: 16/03/2011
Just over one-quarter of gay men with HIV cured of early stage hepatitis C in Amsterdam got it again within two years. The men got hepatitis C from different people the second time.
10 times more reinfection – better prevention needed
The hepatitis C reinfection rate among these Amsterdam HIV positive men is ten times higher than the rate they of first hepatitis C infection among men with HIV.
It is clear that much better health promotion work is needed if men are to avoid reinfection with hepatitis C.
Sexually transmission of hepatitis C among gay and bisexual men happens widely especially in cities like Manchester, Brighton, London, Amsterdam, Berlin, as well as in North America and Australia.
Sex risks and networks
Various explanations have been offered for the greater vulnerability of men with HIV infection, including chosing sexual partners who also have HIV (called sero-sorting), and networks of sexual partners where many of the men have HIV. However it is the sexual and drug-using practices which affects who gets hepatitis C.
Heptatitis C reinfection
Researchers from Amsterdam Academic Medical Centre and the Amsterdam Public Health Service reported HIV+ men reinfected after being successfully treated for hepatitis C.
Twenty-eight men were successfully treated. Two men relapsed and hepatitis C reappeared within two months of the end of their hepatitis C treatment. Of the remaining 26 men, 7 were reinfected within two years, an incidence of 19.6 per 100 person years of follow-up. The time to reinfection was typically one year but could be much sooner.
Different type of hepatitis C
In every man reinfected they had a different genetic version of hepatitis C - three who first had genotype 4 then got genotype 1, while two men who started with genotype 1 get genotype 4 the second time. One man got genotype 1 again but even this was from a different clade, a different subtype.
Better prevention
The researchers say that discussion about prevention measures needs to take place not only at the time of diagnosis, but during and after treatment.
In particular men need to understand all the possible sexual and drug sharing transmission routes, and must to feel free to have frank discussions with doctors about sexual practices, drug-using behaviour and other risk factors. Too many HIV positive men with hepatitis C feel unable to talk freely because they feel judged, shamed and blamed by their HIV clinic.
Keep testing
Regular HCV testing in previously-treated individuals is also essential. We reported recently that while around 8% of gay and bi men with HIV in the UK have hepatitis C, one quarter of positive gay men were not checked for this in 2008, when every person with HIV should be checked at least once a year.
A German study showed similar reinfection among HIV-positive men. 22% became reinfected within six years, despite the number of first hepatitis C infections in Germany falling.
Treatment of acute hepatitis C infection with pegylated interferon and ribavirin prevents early HIV infection progressing to chronic infection, which is harder to treat in HIV-positive people.
European guidelines on treatment of acute hepatitis C infection note that HIV-positive patients have a good response rate to treatment begun within a year of infection.
Source with reference
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