Positive STI test in patients with HIV may indicate risk for HCV reacquisition
A positive STI test may indicate a higher risk for hepatitis C virus reinfection among patients with HIV being treated with direct-acting antivirals, study findings published in Open Forum Infectious Diseases suggest.
“Different studies have shown that condomless sexual practices are associated with HCV transmission and acquisition among HIV-infected men who have sex with men (MSM). We have previously demonstrated that in the interferon era in San Diego, our HCV reinfection rates among non-[injection drug use (IDU)] HIV-infected MSM were 2.6-fold higher than our annual primary HCV infection rates,” Edward R. Cachay, MD, MAS, professor of clinical medicine at the University of California, San Diego, told Healio.
“One of the critical HCV elimination goals outlined by WHO by 2030 — a reduction of 90% in HCV incidence — could be compromised if HCV reinfection rates remain unchanged or higher than the one we observed in the interferon era,” Cachay said.
According to Cachay, it is important to identify potential interventions that can help medical providers identify people at risk for non-IDU HCV reacquisition associated with non-IDU behaviors.
“This could help us design and test interventions to mitigate risk behaviors associated with HCV reinfection in a more targeted and hopefully cost-effective manner,” he said.
Cachay and colleagues assessed an observational longitudinal cohort of people living with HIV (PLWH) treated with DAAs between 2014 and July 2019, who achieved SVR and had at least one subsequent HCV viral load measurement. According to the study, they examined whether screening for STIs and substance use during the pre-SVR period could identify patients at greater risk for reinfection.
Eight of the 200 PLWH in the study were reinfected with HCV after a median time of 26 weeks after achieving SVR, according to the findings. Cachay and colleagues reported that the observed HCV reinfection rate was highest among MSM IDU (4.63/100 person-years of follow-up) and those aged between 30 and 39 years (6.8/100 person-years of follow-up).
They found that a positive gonorrhea-chlamydia nucleic acid amplification test during the pre-SVR period was a predictor of HCV reinfection.
Despite a small cohort size, Cachay said the results provide “objective evidence that having a positive STI test may be a clinical surrogate marker of ongoing high sexual risk behaviors and risk of HCV reacquisition.”
“Our finding should be examined in larger and more diverse treatment cohorts,” he said. “Still, we suggest that the finding makes clinical sense and that those who have a positive gonorrhea or chlamydia test pre-SVR should be monitored more closely and considered at higher risk for HCV reinfection.”