Hep C - relapsed or reinfected?
posted: 29/10/2009
About a third of HIV-positive people who have both hepatitis C and HIV relapse (become ill again) after being treated for hepatitis C. Gay men and people who have ever injected drugs are more likely to have hepatitis C than other people with HIV.
Cure possible, but different strains, relapses and reinfections
Unlike HIV, hepatitis C can be cured. It is treated with two drugs taken together, pegylated interferon and ribavirin. How long you need treatment for depends on which strain of hepatitis C you have. If you have the harder-to-treat genotypes 1 and 4, you need 48 weeks of treatment, but people with genotypes 2 and 3 usually have half this - 24 weeks treatment.
Undetectable hepatitis viral load?
Hepatitis C treatment aims for an undetectable hepatitis C viral load. There are two checks to see if it has worked, once at the end of treatment, and 6 months after treatment ended. If hepatitis is still undetectable after 6 months they call this a sustained virological response, and this is considered to be a cure.
1 in 3 success for people with HIV, but a relapse awaits 1 in 3
But only about a third of people with HIV who have had hepatitis C for a while are 'cured' in this way(a cure is more likely if you start hepatitis treatment soon after getting hepatitis C).
But now researchers have found that about a third of the people who are ‘cured’ of hepatitis C after 6 months find hepatitis C reappears later – they have a relapse. People without HIV, but with hepatitis C don’t normally have this relapse problem.
Researchers checked to see if people had really relapsed or whether they had got hepatitis C from someone else. Nearly all the people had a genuine relapse, although two seem to have been reinfected. But we know from a study in London that many HIV-positive gay men who have a hepatitis C ‘relapse’ had in fact been reinfected.
Reinfection a common risk
In the London study which looked at relapsing gay men, of 211 HIV/hepatitis C coinfected men, 16 got hepatitis C again after successful treatment. Looking at the relapsing men, almost all had yet another sexually transmitted infection at the same time - usually syphilis (ten cases), but also gonorrhoea (six cases) and herpes (three cases).
Last year, Dr Mark Nelson, of the Chelsea & Westminster told the August/September issue of HTU Treatment Update that he finds syphilis and lymphogranuloma venereum (LGV) in many of his patients with hepatitis C, and both of them “make HIV and hepatitis C transmission even more likely.”
Positive gay men need better information
He added that the continued sexual transmission of hepatitis C amongst HIV-positive men “underlines the importance of safer sex messages for HIV-positive men. Some men are having condomless sex because they think that they won’t pass on HIV to someone who already has HIV, or if they have an ‘undetectable’ viral load for HIV, they can’t pass on HIV to anyone. But it does seem they’re passing on—and getting—hepatitis C.”
Dr Jones suggests that healthcare providers are “failing our patients,” since they are becoming infected with hepatitis C not once, but multiple times. Since the paper was published two of the men who had been treated for a second episode of acute hepatitis C had become reinfected for a third time. “We need a much stronger public health information and screening programme” for hepatitis C, she said.
Source aidsmap
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