HCV reinfection incidence and treatment outcome among HIV-positive MSM in London

OBJECTIVE:: Liver disease secondary to hepatitis C virus (HCV) infection in the context of HIV infection is one of the leading non-AIDS causes of death. Sexual transmission of HCV infection among HIV-positive men who have sex with men (MSM) appears to be leading to increased reports of acute HCV infection. Reinfection after successful treatment or spontaneous clearance is reported among HIV-positive MSM but the scale of reinfection is unknown. We calculate and compare HCV reinfection rates among HIV-positive MSM after spontaneous clearance and successful medical treatment of infection. DESIGN:: Retrospective analysis of HIV-positive MSM with sexually acquired HCV who subsequently spontaneously cleared or underwent successful HCV treatment between 2004 and 2012. RESULTS:: Among 191 individuals infected with HCV, 44 were reinfected over 562 person-years of follow-up with an overall reinfection rate of 7.8/100py (95%CI 5.8-10.5). Eight individuals were subsequently reinfected a second time, with a rate of 15.5/100py (95% CI 7.7-31.0). Combining all reinfections, 20% resulted in spontaneous clearance and treatment SVR rates were 73% (16/22) for genotype 1/4 and 100% (2/2) for genotype 2/3.Among 145 individuals with a documented primary infection, the reinfection rate was 8.0 per 100 person-years (95%CI 5.7-11.3) overall, 9.6/100py (95%CI 6.6-14.1) among those successfully treated and 4.2/100py (95%CI 1.7-10.0) among those who spontaneously cleared. The secondary reinfection rate was 23.2/100py (95%CI 11.6-46.4). CONCLUSION:: Despite efforts at reducing risk behaviour, HIV positive MSM who clear HCV infection remain at high risk of reinfection. This emphasizes the need for increased sexual education, surveillance and preventative intervention work.