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HCV REINFECTION AMONG HIV-INFECTED MSM IN NEW YORK CITY
Jesse R. Carollo1, Stephanie H. Factor1, Gabriela Rodriguez-Caprio1, Asa Radix2, Stephen M. Dillon3, Rona Vail2, Krisczar J. Bungay3, Robert Chavez4, José Lares-Guia5, Daniel S. Fierer1
1Icahn School of Medicine at Mt Sinai, New York, NY, USA,2Callen–Lorde Community Health Center, New York, NY, USA,3Gotham Medical Group, New York, NY, USA,4AIDS Healthcare Foundation, New York, NY, USA,5Office of José Lares-Guia, MD, New York, NY, USA
High HCV re-infection rates of 3-15% have been reported after IFN treatment in HIV-infected MSM in Europe. There are no data on HCV re-infection from similar cohorts in the United States, or among those cured with all-oral direct-acting antiviral (DAA) therapy.
We assessed all HIV-infected MSM from our cohort in New York City (NYC) for clearance of HCV. Clearance was defined as SVR 12 if by treatment; or undetectable HCV VL for ≥12 weeks if by spontaneous clearance (SC). Re-infection was defined as new HCV viremia after clearance. Clinical onset of re-infection was defined as the date of the 1st-noted ALT elevation or HCV viremia. Observation time was defined as the period between 12 weeks after completion of therapy or SC, and either the clinical onset of HCV re-infection or the last undetectable HCV VL in those not re-infected.
We identified 267 HIV-infected MSM with documented clearance of primary HCV infection and ≥4 weeks follow-up. Median age was 45; 170 (64%) were white, 40 (15%) black, 55 (21%) Hispanic; genotypes (n=258) were 1a in 206 (80%), 1b in 23 (9%), and other in 29 (11%). Median CD4 count was 579 cells/uL; median HIV VL was <50 copies/mL. We found 44 re-infections among 38 (14%) men, onset between 2006 to 2018, a median of 1.5 (IQR 0.8,2.9; range 0.3-11.4) years after clearance; genotypes (n=41) were 1a in 31 (76%), 1b in 3 (7%), and other in 7 (17%). Including the re-infections, follow-up was available for a total of 300 episodes of HCV clearance, with a median follow-up time of 1.8 (IQR 0.8,3.3; range 0.1-11.4) years, and a total of 734 person-years (PY). The overall re-infection rate was 5.7/100PY (95% CI 4.2,7.7), with no significant difference among the 112 (37%), 160 (53%), or 28 (9%) infections cleared with IFN, DAA, or SC, respectively (p=0.52, Fisher exact). Further, time to re-infection did not differ among the groups (p=0.82, log-rank test) (Figure).
The high HCV re-infection rate in our large cohort of HIV-infected MSM in NYC was independent of whether clearance was by IFN or DAA treatments, or by SC, and comparable to Europe rates. Most re-infections occurred within the first 2 years, but infections continued to occur for more than 11 years after clearance. These data suggest that long-term surveillance is warranted for all HIV-infected MSM after clearance of HCV infection. Further, strategies to reduce HCV re-infections are needed to meet the goal of eliminating HCV in these men who are at significant risk for HCV infection.