In the Journals

No decline in HCV rates among HIV-positive men who have sex with men

Hepatitis C incidence among HIV-positive men who have sex with men has shown no significant decline in Europe, though the trends differ by geographical region and age, according to results of a recently published study.

“While HCV incidence appears to have stabilized in Western Europe and remained stable in Southern Europe, a recent increase in HCV incidence was observed in Northern Europe,” the researchers wrote. “Interestingly, higher HIV RNA levels, recent HIV infection and younger age were associated with higher HCV incidence. The time from HIV seroconversion to HCV infection has significantly shortened in recent years. Hence, routine and continued surveillance following HIV diagnosis is needed.”

The researchers reviewed patient data from 16 cohorts in the CASCADE Collaboration (Concerted Action on SeroConversion to AIDS and Death in Europe) database. HCV incidence trends were estimated from 1990 to 2014 and assessed by a geographical region (model 1), associations with age (model 2) and HIV-related measurements (model 3).

The study included 7,864 men who were recorded as having acquired HIV through sex with men. Median patient age was 34 years, 57% were white and the median year of HIV seroconversion was 2004.

HCV incidence significantly increased from 1990 to 2014 according to model 1 (P < .001) and model 2 (P = .04), ranging from 0.7 per 1,000 person-years (95% CI, 0.1-5) in 1990 to 18 per 1,000 person-years (95% CI, 9-37) in 2014 according to method 1 and from 3 per 1,000 person-years (95% CI, 0.4-18) in 1990 to 21 per 1,000 person-years (95% CI, 10-42) in 2014 according to method 2.

HCV incidence appeared to increase in Northern Europe, but remain stable in Southern Europe. In Western Europe, HCV incidence increased from 14 per 1,000 person-years (95% CI, 10-20) in 2006 to 23 per 1,000 person-years (95% CI, 17-31) in 2009, according to model 1, but declined to 9 per 1,000 person-years (95% CI, 3-27) in 2013.

According to model 2, younger HIV-positive MSM had a higher risk for HCV infection (P = .005). HCV incidence was highest and remained stable until age 35 in Western Europe, increased up until age 35 in Northern and Southern Europe, and declined in all regions after age 35.

According to model 3, higher HIV RNA was associated with higher HCV incidence (P = .001), especially when log10 HIV RNA was 5 copies/mL or greater, and incidence was higher during recent HIV infection than during chronic HIV infection (incidence rate ratio recent vs. chronic = 1.8; 95% CI, 1.1-2.7).

“Given the overall continued rise of HCV incidence, HCV-treatment guidelines should consider recommending direct-acting antivirals during acute HCV infection — when registered — to prevent on-going transmission,” the researchers wrote. “As suggested by modelling studies, the greatest population benefit among HIV-positive MSM can be achieved when HCV treatment is provided within 1 year of HCV diagnosis, together with behavioral interventions.” – by Talitha Bennett

Disclosures: Van Santen reports no relevant financial disclosures. Please see the full study for the other researchers’ relevant financial disclosures.

Hepatitis C incidence among HIV-positive men who have sex with men has shown no significant decline in Europe, though the trends differ by geographical region and age, according to results of a recently published study.

“While HCV incidence appears to have stabilized in Western Europe and remained stable in Southern Europe, a recent increase in HCV incidence was observed in Northern Europe,” the researchers wrote. “Interestingly, higher HIV RNA levels, recent HIV infection and younger age were associated with higher HCV incidence. The time from HIV seroconversion to HCV infection has significantly shortened in recent years. Hence, routine and continued surveillance following HIV diagnosis is needed.”

The researchers reviewed patient data from 16 cohorts in the CASCADE Collaboration (Concerted Action on SeroConversion to AIDS and Death in Europe) database. HCV incidence trends were estimated from 1990 to 2014 and assessed by a geographical region (model 1), associations with age (model 2) and HIV-related measurements (model 3).

The study included 7,864 men who were recorded as having acquired HIV through sex with men. Median patient age was 34 years, 57% were white and the median year of HIV seroconversion was 2004.

HCV incidence significantly increased from 1990 to 2014 according to model 1 (P < .001) and model 2 (P = .04), ranging from 0.7 per 1,000 person-years (95% CI, 0.1-5) in 1990 to 18 per 1,000 person-years (95% CI, 9-37) in 2014 according to method 1 and from 3 per 1,000 person-years (95% CI, 0.4-18) in 1990 to 21 per 1,000 person-years (95% CI, 10-42) in 2014 according to method 2.

HCV incidence appeared to increase in Northern Europe, but remain stable in Southern Europe. In Western Europe, HCV incidence increased from 14 per 1,000 person-years (95% CI, 10-20) in 2006 to 23 per 1,000 person-years (95% CI, 17-31) in 2009, according to model 1, but declined to 9 per 1,000 person-years (95% CI, 3-27) in 2013.

According to model 2, younger HIV-positive MSM had a higher risk for HCV infection (P = .005). HCV incidence was highest and remained stable until age 35 in Western Europe, increased up until age 35 in Northern and Southern Europe, and declined in all regions after age 35.

According to model 3, higher HIV RNA was associated with higher HCV incidence (P = .001), especially when log10 HIV RNA was 5 copies/mL or greater, and incidence was higher during recent HIV infection than during chronic HIV infection (incidence rate ratio recent vs. chronic = 1.8; 95% CI, 1.1-2.7).

“Given the overall continued rise of HCV incidence, HCV-treatment guidelines should consider recommending direct-acting antivirals during acute HCV infection — when registered — to prevent on-going transmission,” the researchers wrote. “As suggested by modelling studies, the greatest population benefit among HIV-positive MSM can be achieved when HCV treatment is provided within 1 year of HCV diagnosis, together with behavioral interventions.” – by Talitha Bennett

Disclosures: Van Santen reports no relevant financial disclosures. Please see the full study for the other researchers’ relevant financial disclosures.