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Jin F, Dore GJ, Matthews G, Luhmann N, Macdonald V, Bajis S, Baggaley R, Mathers B, Verster A, Grulich AE. Prevalence and incidence of hepatitis C virus infection in men who have sex with men: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2020; 6:39-56. [PMID: 33217341 DOI: 10.1016/s2468-1253(20)30303-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND WHO has set targets for hepatitis C virus (HCV) elimination by 2030. We did a global systematic review of HCV prevalence and incidence in men who have sex with men (MSM) to provide updated estimates that can guide community education and public health policy. METHODS We did a systematic review and meta-analysis of studies published and listed on MEDLINE or Embase between Jan 1, 2000, and Oct 31, 2019, including conference proceedings. Studies were eligible if they reported measures of HCV prevalence or HCV incidence (or both) among MSM. Studies that relied on participants' self-reported HCV status with no laboratory confirmation were excluded. Pooled HCV estimates in MSM were stratified by HIV status and by injecting drug use, then by WHO region and by income level. Random-effects meta-analysis was done to account for between-study heterogeneity and examined using the I2 statistic. Pooled HCV prevalence was also compared with HCV estimates in the general population and presented as prevalence ratios (PRs). In HIV-negative MSM, incidence estimates were stratified by use of HIV pre-exposure prophylaxis (PrEP). The systematic review was registered with PROSPERO, number CRD42020156262. FINDINGS Of 1221 publications identified, 194 were deemed to be eligible and included in the systematic review and meta-analysis. Overall, the pooled HCV prevalence in MSM was 3·4% (95% CI 2·8-4·0; I2=98·0%) and was highest in Africa (5·8%, 2·5-10·4) and South-East Asia (5·0%, 0·0-16·6). Globally, HCV prevalence was 1·5% (1·0-2·1) in HIV-negative MSM and 6·3% (5·3-7·5) in HIV-positive MSM. Compared with the general population, HCV prevalence was slightly higher in HIV-negative MSM (PR 1·58, 95% CI 1·14-2·01) and markedly higher (6·22, 5·14-7·29) in HIV-positive MSM. Pooled HCV prevalence was substantially higher in MSM who had ever injected drugs (30·2%, 22·0-39·0) or currently injected drugs (45·6%, 21·6-70·7) than in those who never injected drugs (2·7%, 2·0-3·6). In HIV-negative MSM, the pooled HCV incidence was 0·12 per 1000 person-years (95% CI 0·00-0·72) in individuals not on PrEP and 14·80 per 1000 person-years (9·65-20·95) in individuals on PrEP. HCV incidence in HIV-positive MSM was 8·46 per 1000 person-years (6·78-10·32). INTERPRETATION HIV-positive MSM are at substantially increased risk of HCV. Overall, HIV-negative MSM had a slightly higher prevalence of HCV than the general population but had a lower prevalence than HIV-positive MSM. High HCV incidence in more recent PrEP studies suggests that as PrEP use increases, greater HCV transmission might occur. HCV burden in MSM varies considerably by region, which is likely to be associated with variation in the prevalence of injecting drug use and HIV. FUNDING World Health Organization.
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Affiliation(s)
- Fengyi Jin
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Gregory J Dore
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Gail Matthews
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Niklas Luhmann
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Virginia Macdonald
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Sahar Bajis
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Rachel Baggaley
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Bradley Mathers
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Annette Verster
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Andrew E Grulich
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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2
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Calin R, Massari V, Pialoux G, Reydellet N, Plenel E, Chauvin C, Jauffret-Roustide M, Day N, Kreplak G, Maresca AF, Derche N, Louis S, Pol S, Doré V, Rouzioux C, Chauvin P. Acceptability of on-site rapid HIV/HBV/HCV testing and HBV vaccination among three at-risk populations in distinct community-healthcare outreach centres: the ANRS-SHS 154 CUBE study. BMC Infect Dis 2020; 20:851. [PMID: 33198672 PMCID: PMC7670674 DOI: 10.1186/s12879-020-05601-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 11/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV, HBV and HCV infections continue to represent major health concerns, especially among key at-risk populations such as men who have sex with men (MSM), people who inject drugs (PWIDs), transgender women (TGW) and sex workers (SW). The objective of the ANRS-CUBE study was to evaluate the acceptability of a healthcare, community-based strategy offering a triple rapid HIV-HBV-HCV testing, and HBV vaccination, targeted at three priority groups (MSM, PWIDs and TGW/SWs), in three community centers, in the Paris area. METHODS This longitudinal multicentric non-randomized study included all adult volunteers attending one of the three specialized community centers in Paris, between July 2014 and December 2015. HIV, HBV and HCV status and acceptability of HBV vaccination were evaluated. RESULTS A total of 3662, MSM, 80 PWIDs and 72 TGW/SW were recruited in the three centers respectively. Acceptability of rapid tests was 98.5% in MSM and 14.9% in TGW/SWs, but could not be estimated in PWIDs since the number of users attending and the number of proposals were not recorded. User acceptability of HBV vaccination was weak, only 17.9% of the eligible MSM (neither vaccinated, nor infected) agreed to receive the first dose, 12.2% two doses, 5.9% had a complete vaccination. User acceptability of HBV vaccination was greater in PWIDs and TGW/SWs, but decreased for the last doses (66.7 and 53.3% respectively received a first dose, 24.4 and 26.7% a second dose and 6.7 and 0% a third dose). Fifty-three participants (49 MSM and 4 PWIDs) were discovered HIV positive, more than half with a recent infection. All but two HIV positive participants were linked to appropriate care in less than one month. CONCLUSIONS Rapid HIV-HCV-HBV screening showed a very high level of acceptability among MSM. Efforts need to be made to improve immediate acceptability for HBV vaccination, especially among MSM, and follow-up doses compliance. Our results show the important role of community centers in reaching targets, often fragile, populations, while also suggesting the need to reinforce on-site human support in terms of testing and vaccination, especially when addressing PWIDs.
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Affiliation(s)
- Ruxandra Calin
- Service de Maladies Infectieuses, Hôpital Tenon, Groupe Hospitalier Est, AP-HP, 4 rue de la Chine, 75970, Paris, Cedex 20, France.
- Inserm, IPLESP, ERES, Institut Pierre-Louis d'épidémiologie et de santé publique, Sorbonne Université, 75012, Paris, France.
| | - Véronique Massari
- Inserm, IPLESP, ERES, Institut Pierre-Louis d'épidémiologie et de santé publique, Sorbonne Université, 75012, Paris, France
| | - Gilles Pialoux
- Service de Maladies Infectieuses, Hôpital Tenon, Groupe Hospitalier Est, AP-HP, 4 rue de la Chine, 75970, Paris, Cedex 20, France
- Sorbonne Université, UPMC Université, Paris 06, France
| | | | - Eve Plenel
- Le Kiosque, Checkpoint-Paris, Groupe SOS, Paris, France
| | - Carole Chauvin
- Le Kiosque, Checkpoint-Paris, Groupe SOS, Paris, France
- Cermes3, Inserm U988, CNRS UMR8211, EHESS, Université de Paris, Paris, France
| | | | - Nesrine Day
- Laboratoires Centre Biologique Chemin Vert (CBCV), Paris, France
| | - Georges Kreplak
- Laboratoires Centre Biologique Chemin Vert (CBCV), Paris, France
| | - Anaenza Freire Maresca
- ARCAT, Pasaje Latino, Groupe SOS, Paris, France
- AP-HP, Hôpital Ambroise Pare, Service de Médecine Interne, Boulogne-Billancourt, France
| | | | - Sandra Louis
- CSAPA 110 Les Halles, ARCAT, Groupe SOS, Paris, France
| | - Stanislas Pol
- AP-HP, Hôpital Cochin, Service d'hépatologie, Paris, France
| | - Véronique Doré
- ANRS: Agence Nationale de Recherche sur le sida et les hépatites virales, Paris, France
| | - Christine Rouzioux
- Le Kiosque, Checkpoint-Paris, Groupe SOS, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Pierre Chauvin
- Inserm, IPLESP, ERES, Institut Pierre-Louis d'épidémiologie et de santé publique, Sorbonne Université, 75012, Paris, France
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3
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HCV Genetic Diversity Can Be Used to Infer Infection Recency and Time since Infection. Viruses 2020; 12:v12111241. [PMID: 33142675 PMCID: PMC7692400 DOI: 10.3390/v12111241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/19/2020] [Accepted: 10/27/2020] [Indexed: 11/25/2022] Open
Abstract
HIV-1 genetic diversity can be used to infer time since infection (TSI) and infection recency. We adapted this approach for HCV and identified genomic regions with informative diversity. We included 72 HCV/HIV-1 coinfected participants of the Swiss HIV Cohort Study, for whom reliable estimates of infection date and viral sequences were available. Average pairwise diversity (APD) was calculated over each codon position for the entire open reading frame of HCV. Utilizing cross validation, we evaluated the correlation of APD with TSI, and its ability to infer TSI via a linear model. We additionally studied the ability of diversity to classify infections as recent (infected for <1 year) or chronic, using receiver-operator-characteristic area under the curve (ROC-AUC) in 50 patients whose infection could be unambiguously classified as either recent or chronic. Measuring HCV diversity over third or all codon positions gave similar performances, and notable improvement over first or second codon positions. APD calculated over the entire genome enabled classification of infection recency (ROC-AUC = 0.76). Additionally, APD correlated with TSI (R2 = 0.33) and could predict TSI (mean absolute error = 1.67 years). Restricting the region over which APD was calculated to E2-NS2 further improved accuracy (ROC-AUC = 0.85, R2 = 0.54, mean absolute error = 1.38 years). Genetic diversity in HCV correlates with TSI and is a proxy for infection recency and TSI, even several years post-infection.
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4
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Doyle JS, van Santen DK, Iser D, Sasadeusz J, O'Reilly M, Harney B, Traeger MW, Roney J, Cutts JC, Bowring AL, Winter R, Medland N, Fairley CK, Moore R, Tee B, Asselin J, El-Hayek C, Hoy JF, Matthews GV, Prins M, Stoové MA, Hellard ME. Micro-elimination of hepatitis C among people with HIV coinfection: declining incidence and prevalence accompanying a multi-center treatment scale-up trial. Clin Infect Dis 2020; 73:e2164-e2172. [PMID: 33010149 DOI: 10.1093/cid/ciaa1500] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Gay and bisexual men (GBM) are a key population affected by HIV and hepatitis C (HCV) co-infection. Providing HCV treatment scale-up across specialist and non-hepatitis specialist settings may eliminate HCV in this population. We aimed to (1) deliver and measure HCV treatment effectiveness, and (2) determine the population impact of treatment on HCV prevalence and incidence longitudinally. METHODS The co-EC Study (Enhancing care and treatment among HCV/HIV co-infected individuals to Eliminate Hepatitis C transmission) was an implementation trial providing HCV direct-acting antiviral treatment in Melbourne, Australia, from 2016-2018. Individuals with HCV/HIV co-infection were prospectively enrolled from primary and tertiary-care services providing care for 85% of GBM with HIV in our jurisdiction. HCV-viraemic prevalence and HCV-antibody/viraemic incidence were measured using a state-wide, individually-linked, electronic surveillance system. RESULTS Among 200 participants recruited, 186 initiated treatment during the study period. Sustained virological response among primary care participants (98%, 95%CI:93-100%) was not different to tertiary care (98%, 95%CI:86-100%). From 2012-2019, between 2434 and 3476 GBM with HIV-infection attended our primary-care sites annually providing 13,801 person-years of follow-up; 50-60% received an HCV test annually, 10-14% were anti-HCV positive. Among those anti-HCV positive, viraemic prevalence declined 83% during the study (54% to 9%; 2016 to 2019). HCV incidence decreased 25% annually from 1.7/100 person-years in 2012 to 0.5/100 person-years in 2019 (incidence rate ratio 0.75; CI:0.68-0.83;p<0.001). CONCLUSION High treatment effectiveness by non-specialists demonstrates the feasibility of treatment scale-up in this population. Substantial declines in HCV incidence and prevalence among GBM with HIV-infection provides proof-of-concept for HCV micro-elimination. REGISTRATION ClinicalTrials.gov (Identifier: NCT02786758).
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Affiliation(s)
- J S Doyle
- Burnet Institute, Melbourne, VIC, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia
| | - D K van Santen
- Burnet Institute, Melbourne, VIC, Australia.,School of Population Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - D Iser
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia.,Department of Gastroenterology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - J Sasadeusz
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia.,Victorian Infectious Diseases Service at the Doherty Institute, Melbourne, VIC, Australia
| | - M O'Reilly
- Prahran Market Clinic, Melbourne, VIC, Australia
| | - B Harney
- Burnet Institute, Melbourne, VIC, Australia
| | | | - J Roney
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia
| | - J C Cutts
- Burnet Institute, Melbourne, VIC, Australia
| | | | - R Winter
- Burnet Institute, Melbourne, VIC, Australia
| | - N Medland
- Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, Australia
| | - C K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, Australia
| | - R Moore
- Northside Clinic, Fitzroy North, VIC, Australia
| | - B Tee
- Centre Clinic, Melbourne, VIC, Australia
| | - J Asselin
- Burnet Institute, Melbourne, VIC, Australia
| | - C El-Hayek
- Burnet Institute, Melbourne, VIC, Australia
| | - J F Hoy
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia
| | - G V Matthews
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - M Prins
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Infection and Immunity Institute Amsterdam, the Netherlands.,Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - M A Stoové
- Burnet Institute, Melbourne, VIC, Australia.,School of Population Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - M E Hellard
- Burnet Institute, Melbourne, VIC, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia.,School of Population Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Doherty Institute and Melbourne School of Population and Global Health, University of Melbourne
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5
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Mason LMK, Duffell E, Veldhuijzen IK, Petriti U, Bunge EM, Tavoschi L. Hepatitis B and C prevalence and incidence in key population groups with multiple risk factors in the EU/EEA: a systematic review. Euro Surveill 2019; 24:1800614. [PMID: 31362808 PMCID: PMC6668290 DOI: 10.2807/1560-7917.es.2019.24.30.1800614] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BackgroundPeople living with HIV (PLHIV) and people in prison are population groups with a potentially high risk and/or prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection.AimWe conducted a systematic review in order to find prevalence and incidence estimates in these populations in the European Union/European Economic Area (EU/EEA).MethodsOriginal research articles published between January 2005 and February 2017 were retrieved from PubMed and Embase in February 2017.ResultsFifty-two articles were included, providing 97 estimates of HBV/HCV infection prevalence or incidence. Estimates of HBV infection prevalence ranged between 2.9% and43.4% in PLHIV and 0.0% and 25.2% in people in prison. Estimates of HCV infection prevalence ranged from 2.9% to 43.4% in PLHIV and 0.0% to 25.2% in people in prison. Incidence estimates ranged between 0.0 and 2.5 cases per 100 person-years for HBV infection in PLHIV. No such data was available for people in prison. HCV infection incidence ranged between 0.3 and 0.9 cases per 100 person-years in PLHIV and between 1 and 1.2 cases per 100 person-years in people in prison. Prevalence estimates were generally higher than in the general population, especially for HCV infection and among groups with multiple risk factors.ConclusionsPLHIV, people in prison and groups with multiple risk factors, have a high prevalence of HBV and HCV and may be at ongoing risk of infection. These groups should be among the populations prioritised and targeted for active case finding and prevention programmes in the EU/EEA.
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Affiliation(s)
- Lauren MK Mason
- Pallas Health Research and Consultancy B.V., Rotterdam, Netherlands
| | - Erika Duffell
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Irene K Veldhuijzen
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Uarda Petriti
- Pallas Health Research and Consultancy B.V., Rotterdam, Netherlands
| | - Eveline M Bunge
- Pallas Health Research and Consultancy B.V., Rotterdam, Netherlands
| | - Lara Tavoschi
- European Centre for Disease Prevention and Control, Stockholm, Sweden,Current affiliation: University of Pisa, Pisa, Italy
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Scott N, Stoové M, Wilson DP, Keiser O, El-Hayek C, Doyle J, Hellard M. Eliminating hepatitis C virus as a public health threat among HIV-positive men who have sex with men: a multi-modelling approach to understand differences in sexual risk behaviour. J Int AIDS Soc 2019; 21. [PMID: 29314670 PMCID: PMC5810343 DOI: 10.1002/jia2.25059] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 12/18/2017] [Indexed: 12/12/2022] Open
Abstract
Introduction Outbreaks of hepatitis C virus (HCV) infections among HIV‐positive men who have sex with men (MSM) have been observed globally. Using a multi‐modelling approach we estimate the time and number of direct‐acting antiviral treatment courses required to achieve an 80% reduction in HCV prevalence among HIV‐positive MSM in the state of Victoria, Australia. Methods Three models of HCV transmission, testing and treatment among MSM were compared: a dynamic compartmental model; an agent‐based model (ABM) parametrized to local surveillance and behavioural data (“ABM1”); and an ABM with a more heterogeneous population (“ABM2”) to determine the influence of extreme variations in sexual risk behaviour. Results Among approximately 5000 diagnosed HIV‐positive MSM in Victoria, 10% are co‐infected with HCV. ABM1 estimated that an 80% reduction in HCV prevalence could be achieved in 122 (inter‐quartile range (IQR) 112 to 133) weeks with 523 (IQR 479 to 553) treatments if the average time from HCV diagnosis to treatment was six months. This was reduced to 77 (IQR 69 to 81) weeks if the average time between HCV diagnosis and treatment commencement was decreased to 16 weeks. Estimates were consistent across modelling approaches; however ABM2 produced fewer incident HCV cases, suggesting that treatment‐as‐prevention may be more effective in behaviourally heterogeneous populations. Conclusions Major reductions in HCV prevalence can be achieved among HIV‐positive MSM within two years through routine HCV monitoring and prompt treatment as a part of HIV care. Compartmental models constructed with limited behavioural data are likely to produce conservative estimates compared to models of the same setting with more complex parametrizations.
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Affiliation(s)
- Nick Scott
- Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Vic., Australia
| | - Mark Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Vic., Australia
| | - David P Wilson
- Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia
| | - Olivia Keiser
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Carol El-Hayek
- Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia
| | - Joseph Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Vic., Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Vic., Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Vic., Australia
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7
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Samandari T, Tedaldi E, Armon C, Hart R, Chmiel JS, Brooks JT, Buchacz K. Incidence of Hepatitis C Virus Infection in the Human Immunodeficiency Virus Outpatient Study Cohort, 2000-2013. Open Forum Infect Dis 2017; 4:ofx076. [PMID: 28616444 DOI: 10.1093/ofid/ofx076] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 03/30/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND There are few recent studies of incident hepatitis C virus (HCV) infection among human immunodeficiency virus (HIV)-infected patients in the United States. METHODS We studied HIV Outpatient Study (HOPS) participants seen in 9 HIV-specialty clinics who had ≥1 clinical encounter during 2000-2013 and ≥2 HCV-related tests, the first of which was a negative HCV antibody test (Ab). Hepatitis C virus incident cases were identified by first positive HCV Ab, viral load, or genotype. We assessed rates of incident HCV overall, by calendar intervals, and by demographic and HIV risk strata, and we explored risk factors for incident HCV using Cox proportional hazards models. RESULTS The 1941 eligible patients (median age 40 years, 23% female, 61% men who had sex with men [MSM], and 3% persons who injected drugs [PWID]) experienced 102 (5.3%) incident HCV infections for an overall incidence of 1.07 (95% confidence interval [CI], 0.87-1.30) per 100 person-years (py). Hepatitis C virus incidence decreased from 1.83 in 2000-2003 to 0.88 in 2011-2013 (P = .024), with decreases observed (P < .05) among PWID and heterosexuals, but not among MSM. Overall, MSM comprised 59% of incident cases, and PWID were at most risk for incident HCV infection (adjusted hazard ratio [aHR] for PWID = 4.62 and 95% CI = 2.11-10.13; for MSM, aHR = 1.48 and 95% CI = 0.86-2.55 compared with heterosexuals). CONCLUSIONS Among HIV-infected patients in care during 2000-2013, incidence of HCV infection exceeded 1 case per 100 py. Our findings support recommendations for annual HCV screenings for HIV-infected persons, including persons with only MSM risk, to enable HCV diagnosis and treatment for coinfected individuals.
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Chen Y, Shen C, Guha D, Ding M, Kulich S, Ashimkhanova A, Rinaldo C, Seaberg E, Margolick JB, Stosor V, Martínez-Maza O, Gupta P. Identification of the transcripts associated with spontaneous HCV clearance in individuals co-infected with HIV and HCV. BMC Infect Dis 2016; 16:693. [PMID: 27875997 PMCID: PMC5120459 DOI: 10.1186/s12879-016-2044-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 11/16/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Infection with human immunodeficiency virus (HIV) influences the outcome and natural disease progression of hepatitis C virus (HCV) infection. While the majority of HCV mono-infected and HCV/HIV co-infected subjects develop chronic HCV infection, 20-46% of mono- and co-infected subjects spontaneously clear HCV infection. The mechanism underlying viral clearance is not clearly understood. Analysis of differential cellular gene expression (mRNA) between HIV-infected patients with persistent HCV infection or spontaneous clearance could provide a unique opportunity to decipher the mechanism of HCV clearance. METHODS Plasma RNA from HIV/HCV co-infected subjects who cleared HCV and those who remained chronically infected with HCV was sequenced using Ion Torrent technology. The sequencing results were analyzed to identify transcripts that are associated with HCV clearance by measuring differential gene expression in HIV/HCV co-infected subjects who cleared HCV and those who remained chronically infected with HCV. RESULTS We have identified plasma mRNA, the levels of which are significantly elevated (at least 5 fold, False Discovery Rate (FDR) <0.05) before HCV infection in subjects who cleared HCV compared to those who remained chronically infected. Upon further analysis of these differentially expressed genes, before and after HCV infection, we found that before HCV infection 12 genes were uniquely upregulated in the clearance group compared to the chronically infected group. Importantly, a number of these 12 genes and their upstream regulators (such as CCL3, IL17D, LBP, SOCS3, NFKBIL1, IRF) are associated with innate immune response functions. CONCLUSIONS These results suggest that subjects who spontaneously clear HCV may express these unique genes associated with innate immune functions.
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Affiliation(s)
- Yue Chen
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 2138 Parran Hall, 130 DeSoto Street, Pittsburgh, Pa, 15261, USA.
| | - Chengli Shen
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 2138 Parran Hall, 130 DeSoto Street, Pittsburgh, Pa, 15261, USA
| | - Debjani Guha
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 2138 Parran Hall, 130 DeSoto Street, Pittsburgh, Pa, 15261, USA
| | - Ming Ding
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 2138 Parran Hall, 130 DeSoto Street, Pittsburgh, Pa, 15261, USA
| | - Scott Kulich
- Department of Pathology, VA Hospital, Pittsburgh, Pa, USA
| | - Aiymkul Ashimkhanova
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 2138 Parran Hall, 130 DeSoto Street, Pittsburgh, Pa, 15261, USA
| | - Charles Rinaldo
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 2138 Parran Hall, 130 DeSoto Street, Pittsburgh, Pa, 15261, USA
| | - Eric Seaberg
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Joseph B Margolick
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Valentina Stosor
- Division of Infectious Diseases, School of Medicine, Northwestern University, Chicago, IL, USA
| | - Otoniel Martínez-Maza
- Department of Epidemiology, UCLA Fielding School of Public Health, and Departments of Obstetrics & Gynecology and Microbiology, Immunology & Molecular Genetics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Phalguni Gupta
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 2138 Parran Hall, 130 DeSoto Street, Pittsburgh, Pa, 15261, USA
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Midgard H, Weir A, Palmateer N, Lo Re V, Pineda JA, Macías J, Dalgard O. HCV epidemiology in high-risk groups and the risk of reinfection. J Hepatol 2016; 65:S33-S45. [PMID: 27641987 DOI: 10.1016/j.jhep.2016.07.012] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/08/2016] [Accepted: 07/12/2016] [Indexed: 12/18/2022]
Abstract
Injecting risk behaviours among people who inject drugs (PWID) and high-risk sexual practices among men who have sex with men (MSM) are important routes of hepatitis C virus (HCV) transmission. Current direct-acting antiviral treatment offers unique opportunities for reductions in HCV-related liver disease burden and epidemic control in high-risk groups, but these prospects could be counteracted by HCV reinfection due to on-going risk behaviours after successful treatment. Based on existing data from small and heterogeneous studies of interferon-based treatment, the incidence of reinfection after sustained virological response range from 2-6/100 person years among PWID to 10-15/100 person years among human immunodeficiency virus-infected MSM. These differences mainly reflect heterogeneity in study populations with regards to risk behaviours, but also reflect variations in study designs and applied virological methods. Increasing levels of reinfection are to be expected as we enter the interferon-free treatment era. Individual- and population-level efforts to address and prevent reinfection should therefore be undertaken when providing HCV care for people with on-going risk behaviour. Constructive strategies include acknowledgement, education and counselling, harm reduction optimization, scaled-up treatment including treatment of injecting networks, post-treatment screening, and rapid retreatment of reinfections.
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Affiliation(s)
- Håvard Midgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute for Clinical Medicine, University of Oslo, Norway; Department of Gastroenterology, Oslo University Hospital, Norway.
| | - Amanda Weir
- School of Health and Life Sciences, Glasgow Caledonian University, United Kingdom; NHS National Services Scotland, Health Protection Scotland, Glasgow, United Kingdom
| | - Norah Palmateer
- School of Health and Life Sciences, Glasgow Caledonian University, United Kingdom; NHS National Services Scotland, Health Protection Scotland, Glasgow, United Kingdom
| | - Vincent Lo Re
- Division of Infectious Diseases, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, United States
| | - Juan A Pineda
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, Spain
| | - Juan Macías
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, Spain
| | - Olav Dalgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute for Clinical Medicine, University of Oslo, Norway
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10
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Chan DP, Sun HY, Wong HT, Lee SS, Hung CC. Sexually acquired hepatitis C virus infection: a review. Int J Infect Dis 2016; 49:47-58. [DOI: 10.1016/j.ijid.2016.05.030] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/26/2016] [Accepted: 05/28/2016] [Indexed: 12/19/2022] Open
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11
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Basnayake SK, Easterbrook PJ. Wide variation in estimates of global prevalence and burden of chronic hepatitis B and C infection cited in published literature. J Viral Hepat 2016; 23:545-59. [PMID: 27028545 DOI: 10.1111/jvh.12519] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 01/14/2016] [Indexed: 12/15/2022]
Abstract
To evaluate the extent of heterogeneity in global estimates of chronic hepatitis B (HBV) and C (HCV) cited in the published literature, we undertook a systematic review of the published literature. We identified articles from 2010 to 2014 that had cited global estimates for at least one of ten indicators [prevalence and numbers infected with HBV, HCV, HIV-HBV or HIV-HCV co-infection, and mortality (number of deaths annually) for HBV and HCV]. Overall, 488 articles were retrieved: 239 articles cited a HBV-related global estimate [prevalence (n = 12), number infected (n = 193) and number of annual deaths (n = 82)]; 280 articles had HCV-related global estimates [prevalence (n = 86), number infected (n = 203) and number of annual deaths (n = 31)]; 31 had estimates on both HBV and HCV; 54 had HIV-HBV co-infection estimates [prevalence (n = 42) and number co-infected (n = 12)]; and 68 had estimates for HIV-HCV co-infection [prevalence (n = 40) and number co-infected (n = 28)]. There was considerable heterogeneity in the estimates cited and also a lack of consistency in the terminology used. Although 40% of 488 articles cited WHO as the source of the estimate, many of these were from outdated or secondary sources. Our findings highlight the importance of clear and consistent communication from WHO and other global health agencies on current consensus estimates of hepatitis B and C burden and prevalence, the need for standardisation in their citation, and for regular updates.
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Affiliation(s)
| | - P J Easterbrook
- Global Hepatitis Programme, HIV Department, World Health Organization, Geneva, Switzerland
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12
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Tsai JC, Hung CC, Chang SY, Liu WC, Wu CH, Su YC, Wu PY, Luo YZ, Chang LH, Sun HY, Chang SC. Increasing incidence of recent hepatitis C virus infection among persons seeking voluntary counselling and testing for HIV and sexually transmitted infections in Taiwan. BMJ Open 2015; 5:e008406. [PMID: 26463221 PMCID: PMC4606383 DOI: 10.1136/bmjopen-2015-008406] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 08/05/2015] [Accepted: 09/17/2015] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES The incidence of hepatitis C virus (HCV) infection among HIV-negative men who have sex with men (MSM) is rarely investigated in the Asia-Pacific region. We aimed to estimate the incidence rate of and factors associated with recent HCV infection among the clients seeking voluntary counselling and testing (VCT) services for HIV in Taiwan. METHODS During 2006-2013, 12 143 clients sought VCT services for HIV. Clients with subsequent follow-up tests at an interval of 6 months or longer were included to estimate the incidence rate of HCV seroconversion. Phylogenetic analysis of HCV sequences from VCT clients and HIV-positive patients was performed. RESULTS The overall HCV seroprevalence at baseline was 0.3%. Of 2150 clients testing negative for anti-HCV antibody at baseline with a total of 5074.99 person-years of follow-up (PYFU), 17 (0.8%) developed HCV seroconversion, leading to an overall incidence rate of 3.35 per 1000 PYFU (95% CI 1.76 to 4.94), which increased from 2.28 (95% CI 0.05 to 4.51) in 2006-2009, to 3.33 (95% CI 0.86 to 5.80) in 2010 to 2011 and 4.94 per 1000 PYFU (95% CI 0.99 to 8.99) in 2012-2013; the incidence of early syphilis increased from 11.91 to 13.28 and 31.78 per 1000 PYFU in the three corresponding periods. In multivariate analysis, having HIV-positive partners (adjusted HR (AHR) =3.756; 95%CI 1.180 to 11.955) and developing a rapid plasma reagin titre of 4 or greater (AHR=9.978; 95% CI 1.550 to 64.233) were significantly associated with HCV seroconversion. CONCLUSIONS An increasing trend of recent HCV infection occurs among individuals seeking VCT services in Taiwan. Having HIV-positive partners and having syphilis are independently associated with recent HCV seroconversion.
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Affiliation(s)
- Jen-Chih Tsai
- Department of Internal Medicine, Tzu-Chi Hospital and Tzu-Chi University College of Medicine, Hualien, Taiwan
| | - Chien-Ching Hung
- Departments of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Sui-Yuan Chang
- Departments of Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Chun Liu
- Departments of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Cheng-Hsin Wu
- Departments of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Ching Su
- Departments of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pei-Ying Wu
- Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Zhen Luo
- Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan
| | - Lan-Hsin Chang
- Departments of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsin-Yun Sun
- Departments of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shan-Chwen Chang
- Departments of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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13
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Hullegie SJ, Arends JE, Rijnders BJA, Irving WL, Salmon D, Prins M, Wensing AM, Klenerman P, Leblebicioglu H, Boesecke C, Rockstroh JK, Hoepelman AIM. Current knowledge and future perspectives on acute hepatitis C infection. Clin Microbiol Infect 2015; 21:797.e9-797.e17. [PMID: 25892133 DOI: 10.1016/j.cmi.2015.03.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 03/17/2015] [Accepted: 03/28/2015] [Indexed: 12/13/2022]
Abstract
Acute hepatitis C virus (HCV) 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. Currently used methods to diagnose acute HCV infection are IgG antibody seroconversion and repeated HCV RNA measurements, although no definitive diagnostic test is currently available. Progress in the field of adaptive and innate immune responses has aided both advances in the field of HCV vaccine development and a more basic understanding of viral persistence. The rapid changes in the treatment of chronic HCV infection will affect therapeutic regimens for acute HCV infection 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 hepatitis C epidemiology, virology, immunology, and treatment.
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Affiliation(s)
- S J Hullegie
- Department of Infectious Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - J E Arends
- Department of Infectious Diseases, University Medical Centre Utrecht, Utrecht, The Netherlands; The European Study Group of Viral Hepatitis (ESGVH), UK.
| | - B J A Rijnders
- Department of Infectious Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - W L Irving
- The European Study Group of Viral Hepatitis (ESGVH), UK; NIHR Biomedical Research Unit in Gastroenterology and the Liver, University of Nottingham, Nottingham, UK
| | - D Salmon
- The European Study Group of Viral Hepatitis (ESGVH), UK; Université Paris Descartes, Paris, France
| | - M Prins
- Cluster Infectious Diseases, Department of Research, Public Health Service, Amsterdam, The Netherlands; Department of Infectious Diseases, CINIMA, Academic Medical Centre, Amsterdam, The Netherlands
| | - A M Wensing
- Department of Infectious Diseases, University Medical Centre Utrecht, Utrecht, The Netherlands; The European Study Group of Viral Hepatitis (ESGVH), UK
| | - P Klenerman
- NDM and Jenner Institute, University of Oxford, Oxford, UK
| | - H Leblebicioglu
- The European Study Group of Viral Hepatitis (ESGVH), UK; Department of Infectious Diseases, Ondokuz Mayis University, Samsun, Turkey
| | - C Boesecke
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - J K Rockstroh
- The European Study Group of Viral Hepatitis (ESGVH), UK; Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - A I M Hoepelman
- Department of Infectious Diseases, University Medical Centre Utrecht, Utrecht, The Netherlands; The European Study Group of Viral Hepatitis (ESGVH), UK
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14
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Sobrino-Vegas P, Monge Corella S, Serrano-Villar S, Gutiérrez F, Blanco JR, Santos I, del Romero J, Segura F, Portilla J, Guillén SM, del Amo J. Incidence of hepatitis C virus (HCV) in a multicenter cohort of HIV-positive patients in Spain 2004-2011: increasing rates of HCV diagnosis but not of HCV seroconversions. PLoS One 2014; 9:e116226. [PMID: 25549224 PMCID: PMC4280214 DOI: 10.1371/journal.pone.0116226] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 12/03/2014] [Indexed: 11/19/2022] Open
Abstract
Objectives We aim to describe rates and risk factors of Hepatitis C Virus (HCV) diagnoses, follow-up HCV testing and HCV seroconversion from 2004–2011 in a cohort of HIV-positive persons in Spain. Methods CoRIS is a multicentre, open and prospective cohort recruiting adult HIV-positive patients naïve to antiretroviral therapy. We analysed patients with at least one negative and one follow-up HCV serology. Incidence Rates (IR) were calculated and multivariate Poisson regression was used to estimate adjusted Rates Ratios (aIRR). Results Of 2112 subjects, 53 HCV diagnoses were observed, IR = 0.93/100py (95%CI: 0.7–1.2). IR increased from 0.88 in 2004–05 to 1.36 in 2010–11 (aIRR = 1.55; 95%CI: 0.37–6.55). In men who have sex with men (MSM) from 0.76 to 1.10 (aIRR = 1.45; 95%CI: 0.31–6.82); in heterosexual (HTX) subjects from 1.19 to 1.28 (aIRR = 1.08; 95%CI: 0.11–10.24). HCV seroconversion rates decreased from 1.77 to 0.65 (aIRR = 0.37; 95%CI: 0.12–1.11); in MSM from 1.06 to 0.49 (aIRR = 0.46; 95%CI: 0.09–2.31); in HTX from 2.55 to 0.59 (aIRR = 0.23; 95%CI: 0.06–0.98). HCV infection risk was higher for injecting drug users (IDU) compared to HTX (aIRR = 9.63;95%CI: 2.9–32.2); among MSM, for subjects aged 40–50 compared to 30 or less (IRR = 3.21; 95%CI: 1.7–6.2); and among HTX, for female sex (aIRR = 2.35; 95%CI: 1.03–5.34) and <200 CD4-count (aIRR = 2.39; 95%CI: 0.83–6.89). Conclusion We report increases in HCV diagnoses rates which seem secondary to intensification of HCV follow-up testing but not to rises in HCV infection rates. HCV IR is higher in IDU. In MSM, HCV IR increases with age. Among HTX, HCV IR is higher in women and in subjects with impaired immunological situation.
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Affiliation(s)
- Paz Sobrino-Vegas
- Red de Investigación en Sida, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
- * E-mail:
| | - Susana Monge Corella
- Red de Investigación en Sida, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | | | | | | | | | | | - Julia del Amo
- Red de Investigación en Sida, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - CoRIS
- Cohorte de la Red de Investigación en Sida, Madrid, Spain
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15
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Freiman JM, Huang W, White LF, Geng EH, Hurt CB, Taylor LE, Overton ET, Cachay ER, Kitahata MM, Moore RD, Rodriguez B, Mayer KH, Linas BP. Current practices of screening for incident hepatitis C virus (HCV) infection among HIV-infected, HCV-uninfected individuals in primary care. Clin Infect Dis 2014; 59:1686-93. [PMID: 25186591 PMCID: PMC4311177 DOI: 10.1093/cid/ciu698] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 07/30/2014] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-infected, hepatitis C virus (HCV)-uninfected patients are at risk for incident HCV infection, but little is known about screening practices for incident HCV among HIV-infected individuals in HIV primary care clinics. METHODS We used data from the Center for AIDS Research Network of Integrated Clinical Systems (CNICS) to investigate historical trends in screening for incident HCV infection among HIV-infected patients who were HCV-uninfected at enrollment in care. We used descriptive measures and Poisson regression to identify factors associated with screening for HCV infection (using HCV antibody or RNA), performed temporal analyses to assess changes in screening over time, and investigated the frequency with which elevated alanine aminotransferase (ALT) levels were followed by diagnostic HCV testing. RESULTS Among 17 090 patients registered at CNICS sites between 2000 and 2011, 14 534 (85%) received HCV antibody screening within 3 months of enrolling in care, and 9077 met all of the inclusion criteria. Only 55.6% ever received additional HCV screening. HCV screening increased over time, but not uniformly at all sites. Only 26.7% of first-time ALT elevations to >100 IU/L were followed up within 12 months by HCV antibody or RNA testing. CONCLUSIONS Although most HIV-infected patients were screened for prevalent HCV infection at enrollment in care, only half who were HCV uninfected were screened again. Screening varied between sites, even when controlling for demographics and risk behaviors. Patients with new ALT elevations to >100 IU/L were seldom assessed for incident HCV infection. Guidelines are needed to help HIV providers know whom to screen, how frequently to screen, and which screening test to use.
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Affiliation(s)
- J. Morgan Freiman
- HIVEpidemiology and Outcomes Research Unit, Section of Infectious Diseases, Boston Medical Center
| | - Wei Huang
- HIVEpidemiology and Outcomes Research Unit, Section of Infectious Diseases, Boston Medical Center
| | | | - Elvin H. Geng
- School of Medicine, University of California, San Francisco
| | - Christopher B. Hurt
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill
| | - Lynn E. Taylor
- Department of Medicine, Brown University, Providence, Rhode Island
| | - E. Turner Overton
- Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine
| | | | - Mari M. Kitahata
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle
| | - Richard D. Moore
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland
| | - Benigno Rodriguez
- Division of Infectious Diseases and HIV Medicine, Case Western Reserve University, Cleveland, Ohio
| | | | - Benjamin P. Linas
- HIVEpidemiology and Outcomes Research Unit, Section of Infectious Diseases, Boston Medical Center
- Epidemiology, Boston University School of Public Health, Massachusetts
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16
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Shen C, Gupta P, Xu X, Sanyal A, Rinaldo C, Seaberg E, Margolick JB, Martinez-Maza O, Chen Y. Transmission and evolution of hepatitis C virus in HCV seroconverters in HIV infected subjects. Virology 2013; 449:339-49. [PMID: 24418568 DOI: 10.1016/j.virol.2013.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 10/29/2013] [Accepted: 11/03/2013] [Indexed: 01/06/2023]
Abstract
HIV/HCV co-infection provides a model to determine the role of immunity on HCV transmission and evolution. In this study HCV transmission and evolution were evaluated in 6 HCV seroconverters in HIV-infected subjects with a wide range of CD4 cell count. The HCV envelope E1/E2 sequences were analyzed for transmission bottleneck, viral diversity/divergence, immune pressure, and mutations of HLA class I/II restricted epitopes. HCV infection started with transmission bottleneck in all HIV-infected individuals. During the 1.0-2.0 years of infection there was a shift of viral quasispecies in majority of the subjects from one to next visit. However, HCV diversity, divergence, mutations in HLA class I/II restricted and virus neutralizing epitopes were similar in all subjects regardless of CD4 cell count at the time of HCV infection. Our results suggest that HCV transmission and evolution in HIV-infected subjects may not be influenced by host CD4 cell count at the time of infection.
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Affiliation(s)
- Chengli Shen
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, United States
| | - Phalguni Gupta
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, United States.
| | - Xiaochuan Xu
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, United States
| | - Anwesha Sanyal
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, United States
| | - Charles Rinaldo
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, United States
| | - Eric Seaberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Joseph B Margolick
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | | | - Yue Chen
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, United States.
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Alipour A, Rezaianzadeh A, Hasanzadeh J, Rajaeefard A, Davarpanah MA. Sexual Transmission of Hepatitis C Virus Between HIV Infected Subjects and Their Main Heterosexual Partners. HEPATITIS MONTHLY 2013; 13:e13593. [PMID: 24348647 PMCID: PMC3859182 DOI: 10.5812/hepatmon.13593] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 09/19/2013] [Accepted: 09/28/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Overall, 60-70% of the hepatitis c virus (HCV) transmission routes is parenteral, and in 30-40% of the cases is unknown (e.g. sexual route). Knowing these routes in HIV infected dyads is very important due to clinical and methodological reasons. OBJECTIVES The present study aimed to identify and quantitatively investigate HIV-infected individuals and their main heterosexual partners regarding the risk factors of HCV transmission. PATIENTS AND METHODS One hundred sixty eight of 984 couples were chosen through random generated numbers using a computer program from behavioral consultation center in Shiraz, Iran. We used actor partner independent model (APIM) and multilevel analysis to assess multiple risk factors for HCV, while partitioning the source of risk at the individual and couple levels. RESULTS Age of the index samples was 38.71 ± 7 years, and 33.2 ± 6.3 for their main heterosexual partners; the mean duration of sexual relationship for couples was 11.9 (median = 8.5) years. Multivariate analysis showed that actor risk factor of intravenous drug using (IDU) (AOR= 13.03; 95% CI: 3.9- 43.82) and actor cofactors of HIV positivity (AOR = 7.1; 95% CI: 1.37- 36.97), razor sharing (AOR = 4.81; 95% CI: 1.84- 12.55), sex (AOR = 8.83; 95% CI: 3.16- 24.87), and condom use in sexual activity with main partner (AOR = 0.15; 95% CI: 0.02- 0.44) were associated with actor HCV positivity. CONCLUSIONS Health care providers need to pay special attention to sexual transmission of HCV among HIV-infected individuals, and should recommend control/preventive measures for HCV sexual transmission.
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Affiliation(s)
- Abbas Alipour
- Community Medicine Department, School of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran
- Corresponding author: Abbas Alipour, Thalassemic Research Center, Community Medicine Department, School of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran. Tel: +98-15135430813, Fax: +98-1513543248, E-mail:
| | - Abbas Rezaianzadeh
- Epidemiology Department, School of Health and Nutrition, Research Center for Health Sciences, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Jafar Hasanzadeh
- Epidemiology Department, School of Health and Nutrition, Research Center for Health Sciences, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Abdorreza Rajaeefard
- Epidemiology Department, School of Health and Nutrition, Research Center for Health Sciences, Shiraz University of Medical Sciences, Shiraz, IR Iran
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Abstract
Identification and vaccination of adults at risk for hepatitis B virus acquisition through sexual contact is a key strategy to reduce new hepatitis B virus infections among at-risk adults. Hepatitis C has emerged as a sexually transmitted infection among men with male sex partners (MSM). Several biological and behavioral factors have been linked to hepatitis C virus transmission among MSM, including human immunodeficiency virus coinfection; participation in sexual practices that result in mucosal damage or result in exposure to blood; presence of sexually transmitted diseases (STIs), particularly ulcerative STIs; multiple/casual sex partners; and unprotected anal intercourse.
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Affiliation(s)
- Linda Gorgos
- Special Immunology Associates, El Rio Health Center, 1701 West St Mary's Road, Suite 160, Tucson, AZ 85745, USA.
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19
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Lambers FA, Prins M, Davidovich U, Stolte IG. High awareness of hepatitis C virus (HCV) but limited knowledge of HCV complications among HIV-positive and HIV-negative men who have sex with men. AIDS Care 2013; 26:416-24. [DOI: 10.1080/09540121.2013.832721] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Femke A.E. Lambers
- Cluster of Infectious Diseases, Department of Research, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Maria Prins
- Cluster of Infectious Diseases, Department of Research, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Academic Medical Center, Division of Infectious Diseases, Tropical Medicine and AIDS, (CINIMA), Amsterdam, The Netherlands
| | - Udi Davidovich
- Cluster of Infectious Diseases, Department of Research, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Ineke G. Stolte
- Cluster of Infectious Diseases, Department of Research, Public Health Service of Amsterdam, Amsterdam, The Netherlands
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20
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Abstract
PURPOSE OF REVIEW Increasing evidence has emerged for permucosal transmission of hepatitis C amongst HIV-infected MSM. RECENT FINDINGS A rising incidence of acute hepatitis C virus (HCV) in HIV-infected MSM has been observed since 2000 in Europe, Australia, USA and Asia. Transmission appears to occur through the permucosal rather than the more usual parenteral route. Although often multifactorial, permucosal risk factors can be classified as behavioural (sexual practices and mucosally administered drugs) and biological (HIV and sexually transmitted infections). This review will describe the epidemiology of HCV infection in this cohort. Current and future treatment strategies will also be outlined in the context of novel, orally bioavailable, directly acting antiviral therapies. SUMMARY An improved understanding of HCV epidemiology will allow implementation of more effective public health interventions to limit onward transmission of HCV.
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Abstract
PURPOSE OF REVIEW Persons with HIV are frequently coinfected with hepatitis C virus. We review recent data on the epidemiology and natural history of hepatitis C in HIV-infected persons. RECENT FINDINGS One-quarter of persons with HIV in Europe and the USA also have hepatitis C, but its prevalence in other areas is under 10%. Outbreaks of acute hepatitis C among men having sex with men have been described in Europe. Hepatitis C is the cause of more than three-quarters of liver-related deaths in HIV-seropositive individuals; however, liver-related morbidity and mortality are declining or stable in the era of highly active antiretroviral therapy. The association between hepatitis C virus coinfection and non-liver-related morbidity and mortality is still controversial. HIV-induced immune depression is strongly associated with worse liver disease, but it still does not support an earlier initiation of highly active antiretroviral therapy in coinfected subjects. SUMMARY Screening and management of hepatitis C virus coinfection should be mandatory in persons with HIV, especially in Europe and the USA, where prevention of blood exposure should also be pursued in patients with sexual risk behaviour. The results of ongoing randomized controlled trials are needed before recommending earlier initiation of highly active antiretroviral therapy in coinfected persons.
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22
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Doyle JS, Sacks-Davis R, Hellard ME. Acute Hepatitis C Infection: New Approaches to Surveillance, Treatment and Prevention. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s11901-012-0143-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Estimating incidence rates with misclassified disease status: a likelihood-based approach, with application to hepatitis C virus. Int J Infect Dis 2012; 16:e527-31. [PMID: 22543295 DOI: 10.1016/j.ijid.2012.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 02/20/2012] [Accepted: 02/28/2012] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND In epidemiologic research, incidence is often estimated from data arising from an imperfect diagnostic test performed at unequally spaced intervals over time. METHODS We developed a likelihood-based method to estimate incidence when disease status is measured imperfectly and assays are performed at multiple unequally spaced visits. We assumed conditional independence, no remission, known constant levels of sensitivity and specificity, and constant incidence rates over time. The method performance was evaluated by examining its bias, accuracy (i.e., mean squared error (MSE)), and coverage probability in a simulation study of 4000 datasets, and then we applied the proposed method to a study of hepatitis C virus (HCV) infection in a cohort of pregnant women in the period 1997-2006. RESULTS The simulation revealed that our method has minimal bias and low MSE, as well as good coverage probability of the resulting confidence intervals. In the application to HCV study, the standard incidence rate estimate which ignores the imperfections of the diagnostic test (number of events/person-years), was 13.7 new HCV cases per 1000 person-years (95% confidence interval 10.1, 17.4). The adjusted incidence estimates (obtained using our proposed method) ranged from 0.4 cases per 1000 person-years (when sensitivity and specificity were assumed to both be 95%) to 13.7 cases per 1000 person-years (when sensitivity and specificity were both 100%). The magnitude of difference between standard and adjusted estimates varied depending on specificity and sensitivity assumptions. Specificity had the greatest impact on the magnitude of bias. CONCLUSIONS Scientists should be aware of the impact of misclassification on incidence estimates. Appropriate study design, proper selection of the diagnostic test, and adjustment for misclassification probabilities in the analysis is necessary to obtain the most accurate incidence estimates.
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Linas BP, Wong AY, Schackman BR, Kim AY, Freedberg KA. Cost-effective screening for acute hepatitis C virus infection in HIV-infected men who have sex with men. Clin Infect Dis 2012; 55:279-90. [PMID: 22491339 DOI: 10.1093/cid/cis382] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND We used a Monte Carlo computer simulation to estimate the effectiveness and cost-effectiveness of screening for acute hepatitis C virus (HCV) infection in human immunodeficiency virus (HIV)-infected men who have sex with men. METHODS One-time screening for prevalent HCV infection was performed at the time of enrollment in care, followed by either symptom-based screening, screening with liver function tests (LFTs), HCV antibody (Ab) screening, or HCV RNA screening in various combinations and intervals. We considered both treatment with pegylated interferon and ribavirin (PEG/RBV) alone and with an HCV protease inhibitor. Outcome measures were life expectancy, quality-adjusted life expectancy, direct medical costs, and cost-effectiveness, assuming a societal willingness to pay $100000 per quality-adjusted life-year (QALY) gained. RESULTS All strategies increased life expectancy (from 0.49 to 0.94 life-months), quality-adjusted life expectancy (from 0.47 to 1.00 quality-adjusted life-months), and costs (from $1900 to $7600), compared with symptom-based screening. The incremental cost-effectiveness ratio of screening with 6-month LFTs and a 12-month HCV Ab test, compared with symptom-based screening, was $43 700/QALY (for PEG/RBV alone) and $57 800/QALY (for PEG/RBV plus HCV protease inhibitor). The incremental cost-effectiveness ratio of screening with 3-month LFTs, compared with 6-month LFTs plus a 12-month HCV Ab test, was $129 700/QALY (for PEG/RBV alone) and $229 900/QALY (for PEG/RBV plus HCV protease inhibitor). With HCV protease inhibitor-based therapy, screening with 6-month LFTs and a 12-month HCV Ab test was the optimal strategy when the HCV infection incidence was ≤1.25 cases/100 person-years. The 3-month LFT strategy was optimal when the incidence was >1.25 cases/100 person-years. CONCLUSIONS Screening for acute HCV infection in HIV-infected MSM prolongs life expectancy and is cost-effective. Depending on incidence, regular screening with LFTs, with or without an HCV Ab test, is the optimal strategy.
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Affiliation(s)
- Benjamin P Linas
- HIV Epidemiology and Outcomes Research Unit, Section of Infectious Diseases, Boston Medical Center, Boston, MA 02118, USA.
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Sun HY, Chang SY, Yang ZY, Lu CL, Wu H, Yeh CC, Liu WC, Hsieh CY, Hung CC, Chang SC. Recent hepatitis C virus infections in HIV-infected patients in Taiwan: incidence and risk factors. J Clin Microbiol 2012; 50:781-7. [PMID: 22189113 PMCID: PMC3295121 DOI: 10.1128/jcm.06014-11] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 12/09/2011] [Indexed: 02/07/2023] Open
Abstract
Outbreaks of sexually transmitted hepatitis C virus (HCV) infections have been recently reported in HIV-infected men who have sex with men (MSM) in Europe, Australia, and North America. Little is known concerning whether this also occurs in other Asia-Pacific countries. Between 1994 and 2010, a prospective observational cohort study was performed to assess the incidence of recent HCV seroconversion in 892 HIV-infected patients (731 MSM and 161 heterosexuals) who were not injecting drug users. A nested case-control study was conducted to identify associated factors with recent HCV seroconversion, and phylogenetic analysis was performed using NS5B sequences amplified from seroconverters. During a total followup duration of 4,270 person-years (PY), 30 patients (3.36%) had HCV seroconversion, with an overall incidence rate of 7.03 per 1,000 PY. The rate increased from 0 in 1994 to 2000 and 2.29 in 2001 to 2005 to 10.13 per 1,000 PY in 2006 to 2010 (P < 0.05). After adjustment for age and HIV transmission route, recent syphilis remained an independent factor associated with HCV seroconversion (odds ratio, 7.731; 95% confidence interval, 3.131 to 19.086; P < 0.01). In a nested case-control study, seroconverters had higher aminotranferase levels and were more likely to have CD4 ≥ 200 cells/μl and recent syphilis than nonseroconverters (P < 0.05). Among the 21 patients with HCV viremia, phylogenetic analysis revealed 7 HCV transmission clusters or pairs (4 within genotype 1b, 2 within genotype 2a, and 1 within genotype 3a). The incidence of HCV seroconversion that is associated with recent syphilis is increasing among HIV-infected patients in Taiwan.
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Affiliation(s)
- Hsin-Yun Sun
- Departments of Internal Medicinea and Laboratory Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
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Obermeier M, Ingiliz P, Weitner L, Cordes C, Moll A, Hintsche B, Schlote F, Koeppe S, Christensen S, Mayr C, Baumgarten A. Acute hepatitis C in persons infected with the human immunodeficiency virus (HIV): the "real-life setting" proves the concept. Eur J Med Res 2011; 16:237-42. [PMID: 21719398 PMCID: PMC3352197 DOI: 10.1186/2047-783x-16-5-237] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objectives Outbreaks of sexually transmitted acute HCV infection have been described recently in several cities in the western world. The epidemic affects mainly MSM who are coinfected with HIV and is supposably linked to certain sexual risk practices. Here, we compared our findings with current knowledge and recommendations. Methods HIV-positive patients with the diagnosis of acute HCV infection were included in the retrospective analysis. The patients came from outpatient infectious disease centers in northern German cities. We looked at markers of HIV and HCV infection and compared patients who received treatment and those who did not. Treated patients were followed up to 72 weeks. Results Three hundred nineteen HIV-positive patients with the diagnosis of acute hepatitis C between 2001 and 2008 and were included in the analysis. All patients were male, 315 (99%) patients were of caucasian origin, 296 (93%) declared homosexual contacts as a risk factor for HCV infection, intravenous drug use was declared in 3 (1%) cases. Median age at HCV diagnosis was 40 years (range 20-69 years). Median HCV viral load was 1.2 × 106 IU/mL, 222 patients (70%) had HCV genotype 1, 59 (18%) genotype 4. The median time of HIV infection was 5.5 years (range 0 to 22.4 years). Median HIV viral load was 110 copies/mL (range 25 to 10 × 106 copies/mL). The median CD 4 count was 461 cells/mm3 (range 55- 1331 cells/mm3). Two hundred and fourty-six patients (77%) received anti-HCV treatment, and 175 (55%) had completed therapy by the time of the analysis. Median treatment duration was 33 weeks (IQR 24.1-49.9). 93 of the 175 treated patients (53%) reached a sustained virological response (SVR). In the multivariate analysis, ART at diagnosis, HCV RNA drop at week 12, hemoglobin levels and higher platelets were associated with SVR. Treatment duration was significantly higher in the SVR group (40.6 weeks vs 26.6 weeks, p < 0.0001). Seventy-three patients (23%) did not receive anti-HCV treatment. In 19 of the untreated patients (26%) the hepatitis C virus was cleared spontaneously. Conclusions Our findings confirm that acute hepatitis C in HIV infected patients affects mainly MSM who acquire HCV sexually. Patients had a short duration of HIV infection and a stable immunological situation. In this real-life setting from urban regions in northern Germany, treatment rates appear to be high and effective.
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Affiliation(s)
- M Obermeier
- Medical Center for Infectious Diseases (MIB), Seestr. 13, 13353 Berlin, Germany
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Epidemic of Sexually Transmitted Hepatitis C Virus Infection Among HIV-Infected Men. Curr Infect Dis Rep 2011; 12:118-25. [PMID: 21308508 DOI: 10.1007/s11908-010-0088-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Sexual contact is thought to be an inefficient mode of hepatitis C virus (HCV) transmission. However, reports of sexually transmitted HCV infection among HIV-infected men who have sex with men (MSM) began to appear in 2004. The patients were of early middle age with well-controlled HIV infection, participated in unprotected receptive sex, and frequently used noninjection recreational drugs. Molecular studies showed evidence of clusters of transmission between patients in different countries in Europe. Spontaneous clearance was relatively rare, but treatment with pegylated interferon and ribavirin resulted in cure in about two thirds of patients. Of concern was the finding of moderately advanced fibrosis during the early stages of HCV infection. HIV-infected MSM are a new risk group for HCV infection and so should be screened regularly for HCV infection.
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Abstract
BACKGROUND Outbreaks of acute hepatitis C virus (HCV) infection among HIV-infected MSM have been described since 2000. However, phylogenetic analysis suggests that the spread of HCV started around 1996. We estimated the incidence of HCV in HIV-infected MSM with well estimated dates of HIV seroconversion from 1990 to 2007. METHODS Data from 12 cohorts within the Concerted Action on SeroConversion to AIDS and Death in Europe (CASCADE) Collaboration were used. HCV incidence was estimated using standard incidence methods and methods for interval-censored data. We accounted for the fact that routine HCV data collection in each cohort started in different calendar years. RESULTS Of 4724 MSM, 3014 had an HCV test result and were included. Of these, 124 (4%) had only positive HCV test results, 2798 (93%) had only negative results and 92 (3%) had both. In 1990, HCV incidence ranged from 0.9 to 2.2 per 1000 person-years, depending on the analysis strategy used. HCV incidence increased up to 1995 when it was estimated to range between 5.5 and 8.1 per 1000 person-years. From 2002 onwards, it increased substantially to values between 16.8 and 30.0 per 1000 person-years in 2005 and between 23.4 and 51.1 per 1000 person-years in 2007. CONCLUSION Our data support phylodynamic findings that HCV incidence had already increased among HIV-infected MSM from the mid-1990s. However, the main expansion of the HCV epidemic started after 2002. Incidence estimates obtained from cohort studies may help identify changes in the spread of important infections earlier and should guide routine testing policies to minimize further disease burden.
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Abstract
In developed nations, the majority of new HCV infections are acquired by injection drug users. Acute HCV infection is generally asymptomatic and is followed by spontaneous viral clearance in approximately 25% of individuals. However, given the asymptomatic nature of infection and difficulties in identifying and following those at risk of acquiring infection, our knowledge of treatment for acute HCV infection has been hampered. Much of what is known about the timing, optimal regimen and duration of therapy comes from small, prospective, observational studies and randomized, controlled trials in selected populations. Furthermore, data on the treatment of acute HCV infection among injection drug users and patients co-infected with HCV and HIV are limited. Genetic testing for variations in IL28B may provide an additional diagnostic tool for the optimal management and treatment of acute HCV infection. This Review highlights current knowledge of the epidemiology, diagnosis, natural history and treatment of acute HCV infection, including proposed recommendations for the assessment and treatment of this infection.
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Affiliation(s)
- Jason Grebely
- Viral Hepatitis Clinical Research Program, National Center in HIV Epidemiology and Clinical Research, University of New South Wales, Corner Boundary and West Streets, Darlinghurst, Sydney, NSW 2010, Australia.
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Schmidt AJ, Rockstroh JK, Vogel M, An der Heiden M, Baillot A, Krznaric I, Radun D. Trouble with bleeding: risk factors for acute hepatitis C among HIV-positive gay men from Germany--a case-control study. PLoS One 2011; 6:e17781. [PMID: 21408083 PMCID: PMC3050932 DOI: 10.1371/journal.pone.0017781] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 02/10/2011] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To identify risk factors for hepatitis C among HIV-positive men who have sex with men (MSM), focusing on potential sexual, nosocomial, and other non-sexual determinants. BACKGROUND Outbreaks of hepatitis C virus (HCV) infections among HIV-positive MSM have been reported by clinicians in post-industrialized countries since 2000. The sexual acquisition of HCV by gay men who are HIV positive is not, however, fully understood. METHODS Between 2006 and 2008, a case-control study was embedded into a behavioural survey of MSM in Germany. Cases were HIV-positive and acutely HCV-co-infected, with no history of injection drug use. HIV-positive MSM without known HCV infection, matched for age group, served as controls. The HCV-serostatus of controls was assessed by serological testing of dried blood specimens. Univariable and multivariable regression analyses were used to identify factors independently associated with HCV-co-infection. RESULTS 34 cases and 67 controls were included. Sex-associated rectal bleeding, receptive fisting and snorting cocaine/amphetamines, combined with group sex, were independently associated with case status. Among cases, surgical interventions overlapped with sex-associated rectal bleeding. CONCLUSIONS Sexual practices leading to rectal bleeding, and snorting drugs in settings of increased HCV-prevalence are risk factors for acute hepatitis C. We suggest that sharing snorting equipment as well as sharing sexual partners might be modes of sexual transmission. Condoms and gloves may not provide adequate protection if they are contaminated with blood. Public health interventions for HIV-positive gay men should address the role of blood in sexual risk behaviour. Further research is needed into the interplay of proctosurgery and sex-associated rectal bleeding.
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Affiliation(s)
- Axel J Schmidt
- Department for Infectious Diseases Epidemiology, Robert Koch Institute, Berlin, Germany.
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Acute hepatitis C in HIV-infected individuals: recommendations from the European AIDS Treatment Network (NEAT) consensus conference. AIDS 2011; 25:399-409. [PMID: 21139491 DOI: 10.1097/qad.0b013e328343443b] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Gamage DG, Read TRH, Bradshaw CS, Hocking JS, Howley K, Chen MY, Fairley CK. Incidence of hepatitis-C among HIV infected men who have sex with men (MSM) attending a sexual health service: a cohort study. BMC Infect Dis 2011; 11:39. [PMID: 21291565 PMCID: PMC3040713 DOI: 10.1186/1471-2334-11-39] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 02/03/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to determine the incidence of Hepatitis C (HCV) infection among HIV-infected men who have sex with men (MSM) attending a Sexual Health Centre. METHODS A retrospective cohort study was carried out among HIV-infected MSM seen at least once between February 2002 and March 2010. The analysis was restricted to MSM who had had a negative HCV antibody test at least 6 months after their diagnosis for HIV. Duration of follow up was taken from the date of HIV diagnosis to the first positive or last negative HCV antibody test. RESULTS During the time 1445 HIV-infected men attended the clinic of whom 1065 (74%) were MSM. Of these, 869 (82%) were tested for HCV at any time after HIV diagnosis. Of these 869, 69% (620) tested HCV negative at least 6 months after their HIV diagnosis. These 620 men had a mean age of 34 years (range 17-72) at HIV diagnosis and a total of 4,359 person years (PY) of follow up. There were 40 incident cases of HCV, of which 16 were in injecting drug users (IDU) and 24 in non-IDU. The overall incidence of HCV among HIV-infected MSM was 0.9/100 PY (95% CI 0.6-1.2). The incidence among HIV-infected IDU was 4.7/100 PY (95% CI 2.7-7.5) while the incidence among HIV-infected non-IDU was 0.6/100 PY (95% CI 0.4-0.8) (hazard ratio of 8.7 and 95% CI 4.6-16.6, P < 0.001).The majority (78%) were tested for HCV because they developed abnormal liver transaminases (n = 31) or hepatitis symptoms (n = 2), while others (n = 7) were identified through routine HCV testing. CONCLUSION A considerable proportion of HIV-positive MSM who did not inject drugs contracted HCV, presumably via sexual transmission and the main trigger for investigation was abnormal liver transaminases.
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Affiliation(s)
- Deepa G Gamage
- Melbourne Sexual Health Centre, Alfred Hospital, Melbourne, Australia
- Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka
| | - Tim RH Read
- Melbourne Sexual Health Centre, Alfred Hospital, Melbourne, Australia
- School of Population Health, University of Melbourne, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Hospital, Melbourne, Australia
- School of Population Health, University of Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Australia
| | - Jane S Hocking
- School of Population Health, University of Melbourne, Australia
| | - Kerry Howley
- Melbourne Sexual Health Centre, Alfred Hospital, Melbourne, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Hospital, Melbourne, Australia
- School of Population Health, University of Melbourne, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Hospital, Melbourne, Australia
- School of Population Health, University of Melbourne, Australia
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Abstract
UNLABELLED Medical opinion varies considerably regarding the transmission of hepatitis C virus (HCV) through sexual contact. Based on the study design, representativeness of the study population, and the methods used for case ascertainment, we analyzed 80 qualifying reports regarding the evidence for or against sexual transmission. Regarding heterosexual transmission, the weight of evidence is that there is no increased risk of sexual transmission of HCV among heterosexual couples in regular relationships. This risk increases among persons with multiple sexual partners (adjusted odds ratio [aOR] 2.2-2.9), but this association may be confounded by increased likelihood of injection drug use with increased number of partners. There appears to be a real increased risk for women coinfected with human immunodeficiency virus (HIV) or other sexually transmitted infections (aOR 3.3-3.9) and especially for HIV-infected gay men who are having sex with one another compared with HIV-uninfected men (aOR 4.1-5.7). HIV-infected gay men increase their risk of such transmission in association with practices that lead to mucosal trauma (multiple sexual partners, fisting, use of sex toys) and the presence of genital ulcerative disease. CONCLUSION This review should inform, and not distract from, recommendations to reduce the risk of HCV transmission. Health care providers need to pay special attention to sexual transmission of HCV among HIV-infected individuals.
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Affiliation(s)
- Rania A Tohme
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA, USA.
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Vogel M, van de Laar T, Kupfer B, Stellbrink HJ, Kümmerle T, Mauss S, Knecht G, Berger A, Bruisten S, Rockstroh JK. Phylogenetic analysis of acute hepatitis C virus genotype 4 infections among human immunodeficiency virus-positive men who have sex with men in Germany. Liver Int 2010; 30:1169-72. [PMID: 20633101 DOI: 10.1111/j.1478-3231.2010.02305.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND An ongoing HCV epidemic currently affects a growing proportion of HIV-positive men who have sex with men (MSM) in Europe. Recently in the North-Rhine region of Germany, we have observed an increase in acute HCV infections of genotype 4 (HCV-4). AIMS To characterize the current spread of HCV-4 among German MSM using a molecular epidemiological approach. METHODS Patient characteristics and sera were collected for HIV-positive MSM diagnosed with acute HCV-4 infections in the North-Rhine region (n=14), Hamburg (n=14), Frankfurt (n=4) and Berlin (n=4). Part of the HCV NS5B region (436 bp) was amplified, sequenced and compared with HCV-4 sequences from HIV-positive Dutch, English and French MSM (n=50) as well as unrelated HCV risk groups (n=61). RESULTS NS5B sequences were obtained from 35/36 (97%) of German cases, all of which were HCV subtype 4d (HCV-4d). The phylogenetic analysis of HCV sequences revealed two MSM-specific HCV-4d clusters of 71 and 12 sequences. All except one of the German MSM belonged to a large MSM-specific HCV cluster containing MSM from all four different European countries. None of the HCV-4 strains circulating among injecting drug users or in HCV-4 endemic areas were part of the MSM-specific clusters. CONCLUSIONS HCV rapidly spreads among European HIV-positive MSM through a joint international transmission network, separate from that of injecting drug users. In order to contain this epidemic, non-parenteral routes of transmission, such as unsafe sex, must be taken into consideration and prevention measures should be refocused accordingly.
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Affiliation(s)
- Martin Vogel
- Department of Internal Medicine I, University of Bonn, Bonn, Germany.
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Brook G, Main J, Nelson M, Bhagani S, Wilkins E, Leen C, Fisher M, Gilleece Y, Gilson R, Freedman A, Kulasegaram R, Agarwal K, Sabin C, Deacon-Adams C. British HIV Association guidelines for the management of coinfection with HIV-1 and hepatitis B or C virus 2010. HIV Med 2010; 11:1-30. [PMID: 20059574 DOI: 10.1111/j.1468-1293.2009.00781.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- G Brook
- British HIV Association (BHIVA), BHIVA Secretariat, Mediscript Ltd, London, UK.
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Acute hepatitis C in HIV-infected men who have sex with men: an emerging sexually transmitted infection. AIDS 2010; 24:1799-812. [PMID: 20601854 DOI: 10.1097/qad.0b013e32833c11a5] [Citation(s) in RCA: 174] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
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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Jost JJ, Goldsamt LA, Harocopos A, Kobrak P, Clatts MC. Hepatitis C knowledge among new injection drug users. DRUGS-EDUCATION PREVENTION AND POLICY 2010. [DOI: 10.3109/09687630902858948] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Vogel M, Rockstroh JK. Treatment of acute hepatitis C in HIV infection. J Antimicrob Chemother 2009; 65:4-9. [DOI: 10.1093/jac/dkp385] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Matthews GV, Grebely J, Dore GJ. The role of re-infection in determining rates of spontaneous clearance after hepatitis C exposure. J Hepatol 2008; 49:305-7. [PMID: 18644647 DOI: 10.1016/j.jhep.2008.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Pelgrom JM, Vogelaers D, Colle I. Hepatitis C-seroconversion within three to six months after having contracted clinical syphilis and/or lymphogranuloma venereum rectitis in five homosexually active, HIV seropositive men. Acta Clin Belg 2008; 63:335-8. [PMID: 19186567 DOI: 10.1179/acb.2008.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Five Human Immunodeficiency Virus (HIV) seropositive homosexually active men experienced hepatitis C-seroconversion in the period between September 2004 and January 2007 at a single HIV Reference Center (University Hospital Ghent, Belgium). There was no history of intravenous drug use. All had unprotected anal sex with multiple other HIV seropositive men in the recent past. All of them had clinical syphilis and/or lymphogranuloma venereum rectitis within three to six months before the hepatitis C-seroconversion was detected. This confirms the observations in other case reports and studies originating from the Netherlands, France, the United Kingdom and Germany, illustrating sexual transmission of hepatitis C virus (HCV) infection in this high-risk group. Physicians should be aware of the persistent high-risk behaviour in a subgroup of HIV seropositive homosexually active men and perform intensive sexual counselling and screening for other sexually transmitted diseases, including HCV, during medical follow-up.
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Affiliation(s)
- J M Pelgrom
- University Hospital Ghent, 1P2, HIV Reference Center, De Pintelaan 185, 9000 Gent, Belgium.
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Wolff FH, Fuchs SC, Barcellos NT, Falavigna M, Cohen M, Brandão ABM, Fuchs FD. Risk factors for hepatitis C virus infection in individuals infected with the HIV. Dig Liver Dis 2008; 40:460-7. [PMID: 18096448 DOI: 10.1016/j.dld.2007.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Revised: 11/05/2007] [Accepted: 11/07/2007] [Indexed: 12/11/2022]
Abstract
BACKGROUND Except for injecting drug use, other routes of transmission for hepatitis C virus among HIV-AIDS patients have not been consistently described, and risk estimates are often not adjusted for confounding factors. AIMS To evaluate characteristics associated with hepatitis C virus infection in individuals infected with the HIV. PATIENTS Cases were patients co-infected by HIV and hepatitis C virus, and controls were infected only by HIV. METHODS Cases and controls were consecutively enrolled at a public health care outpatient HIV-AIDS reference centre in Porto Alegre, Southern Brazil. RESULTS A total of 227 cases (63% men; 40.3+/-8.7 years) and 370 controls (44.6% men; 38.9+/-9.8 years) were enrolled in the study. In a multiple logistic regression model, male gender (odds ratio 1.9; 95% confidence interval 1.3-2.7), age between 30 and 49 years (odds ratio 2.1; 95% confidence interval 1.2-3.7), elementary school education (odds ratio 4.2; 95% confidence interval 1.9-9.6), lower family income (odds ratio 1.7; 95% confidence interval 1.1-2.7), sharing personal hygiene objects (odds ratio 2.0; 95% confidence interval 1.3-3.3), using injected drugs (odds ratio 21.6; 95% confidence interval 10.8-43.0) and crack cocaine (odds ratio 2.8; 95% confidence interval 1.1-6.9) were independently associated with co-infection by hepatitis C virus. CONCLUSION These results confirm the risk profile for hepatitis C virus-HIV infection and suggest that sharing personal hygiene objects might explain the transmission of virus C to those not infected by the usual routes, which may be of relevance for developing preventive strategies.
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Affiliation(s)
- F H Wolff
- Post-Graduate Program in Medical Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
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Sexually transmitted hepatitis C virus superinfection in HIV/hepatitis C virus co-infected men who have sex with men. AIDS 2008; 22:658-61. [PMID: 18317011 DOI: 10.1097/qad.0b013e3282f4e86f] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We report two cases of sexually transmitted hepatitis C virus (HCV) superinfection in HIV/HCV-co-infected patients with high-risk sexual behaviour. The two patients had chronic HCV and a history of sexually transmitted infections. HCV superinfection was confirmed by phylogenetic analysis. No risk factors for HCV were found except unprotected anal sex with multiple casual male partners. HCV serology and serum HCV RNA should be examined periodically in HIV-infected men who have sex with men engaging in high-risk sexual behaviours.
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Affiliation(s)
- Jason T Blackard
- Division of Digestive Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Buffington J, Murray PJ, Schlanger K, Shih L, Badsgard T, Hennessy RR, Wood R, Weisfuse IB, Gunn RA. Low prevalence of hepatitis C virus antibody in men who have sex with men who do not inject drugs. Public Health Rep 2007; 122 Suppl 2:63-7. [PMID: 17542456 PMCID: PMC1831798 DOI: 10.1177/00333549071220s212] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE It is well documented that injection drug users (IDUs) have a high prevalence of antibodies to hepatitis C virus (HCV). Sexual transmission of HCV can occur, but studies have shown that men who have sex with men (MSM) without a history of injection drug use are not at increased risk for infection. Still, some health-care providers believe that all MSM should be routinely tested for HCV infection. To better understand the potential role of MSM in risk for HCV infection, we compared the prevalence of antibody to HCV (anti-HCV) in non-IDU MSM with that among other non-IDU men at sexually transmitted disease (STD) clinics and human immunodeficiency virus (HIV) counseling and testing sites in three cities. METHODS During 1999-2003, public health STD clinics or HIV testing programs in Seattle, San Diego, and New York City offered counseling and testing for anti-HCV for varying periods to all clients. Sera were tested using enzyme immunoassays, and final results reported using either the signal-to-cutoff ratio or recombinant immunoblot assay results. Age, sex, and risk information were collected. Prevalence ratios and 95% confidence intervals were calculated. RESULTS Anti-HCV prevalence among IDUs (men and women) was between 47% and 57% at each site, with an overall prevalence of 51% (451/887). Of 1,699 non-IDU MSM, 26 (1.5%) tested anti-HCV positive, compared with 126 (3.6%) of 3,455 other non-IDU men (prevalence ratio 0.42, 95% confidence interval 0.28, 0.64). CONCLUSION The low prevalence of anti-HCV among non-IDU MSM in urban public health clinics does not support routine HCV testing of all MSM.
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Affiliation(s)
- Joanna Buffington
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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