For men who have sex with men (MSM) coinfected with HIV and hepatitis C virus (HCV), the rate of HCV reinfection after sustained virologic response is a matter of concern in the Madrid, Spain, region, according to a study published in AIDS.

The study included 2359 participants (1459 self-described as people who inject drugs [PWID], 177 as MSM) from a prospective registry of patients coinfected with HIV/HCV who were treated with all-oral direct-acting antiviral-based therapy in the region of Madrid. The study period spanned from the date of confirmed sustained virologic response to December 31, 2017. Sustained virologic response was defined as undetectable plasma HCV-RNA 12 weeks after finishing treatment. Reinfection was defined as a positive HCV-RNA test result after achieving sustained virologic response.

Overall, 17 participants had an HCV reinfection: 12 reinfections occurred in MSM and 5 in PWID. All 12 MSM had unprotected anal sex with multiple partners, frequently accompanied by drug use and concomitant sexually transmitted infections. Reinfection was caused by a different HCV genotype in 10 people. The median time for the detection of reinfection was 15 weeks after sustained virologic response.

The researchers calculated the incidence of reinfection per 100 person-years, which was 0.48 overall, 5.93 for MSM, and 0.21 for PWID.

The 15-week median time to HCV reinfection suggests that participants continued to engage in risky behavior shortly after or even during direct-acting antiviral therapy. The 28 times higher rate of HCV reinfection in MSM compared with PWID shows that “MSM who engage in high-risk sexual practices and substance use are the population group fuelling new HCV transmission events in [the Madrid] region, as is the case in major cities in Europe,” noted the researchers.

“This public health problem should be addressed with a triple strategy comprising targeted screening for HCV infection after cure in MSM with high-risk practices for reinfection, rapid treatment of reinfection in order to interrupt the chain of transmission and behavioural and traditional harm reduction interventions to prevent high-risk behaviour in this population group,” concluded the researchers.

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Disclosure: Juan Berenguer and Juan J. González-García have received research grants from AbbVie, Gilead Sciences, and Merck, as well as personal fees from AbbVie, Gilead Sciences, Janssen, and Merck. María L. Montes has received personal fees from AbbVie, Gilead Sciences, and Janssen. Juan E. Losa has received personal fees from AbbVie, Gilead Sciences, and Merck.

Reference

Berenguer J, Gil-Martin A, Jarrin I, et al; Madrid-CoRe Study Group. Reinfection by hepatitis C virus following effective all-oral direct-acting antiviral drug therapy in HIV/hepatitis C virus coinfected individuals. AIDS. 2019;33(4):685-689.