Conference Coverage

Most HIV patients need treatment for acute HCV



– Fewer than 12% of HIV infected men will clear new hepatitis C infections on their own.

If they haven’t had a 2-log drop in their hepatitis C virus (HCV) RNA loads after a month, they aren’t going to clear the infection, and need direct-acting antiretrovirals (DAAs), according to an observational European study of 465 HIV patients with newly acquired HCV infections, almost all of them men who have sex with men (MSM).

The findings spoke to a hot topic at the Conference on Retroviruses & Opportunistic Infections (CROI): DAAs for acute HCV infection in patients with HIV. It’s a pressing problem; the incidence of sexually transmitted HCV among MSM with HIV is rising worldwide.

Dr. David Thomas

However, on both sides of the Atlantic, DAAs are indicated only for chronic HCV, which usually means infection for 6 months or more, because a third or so of patients will clear the infection on their own. The drugs are expensive, and reimbursements don’t generally kick in until after the waiting period.

That’s a problem with HIV coinfection, and not just because far fewer patients will rid themselves of the virus. HCV is most likely to be spread by sexual contact in the acute phase; allowing patients destined to become chronic carriers to linger without treatment means that the infection will probably spread to new partners, according to researchers at CROI,

Proactive measures could help. Swiss investigators reported a 50% drop in new HCV infections when HIV-positive MSM were screened for the infection then treated immediately with DAAs. Some at the meeting argued that HCV screening – and treatment – should be automatic for patients taking pre-exposure HIV prophylaxis, as well as for newly diagnosed HIV.

Several said that, on a population level, treatment in the acute phase would save money by preventing new infections. It’s also cheaper to treat in the acute phase because coinfected patients only need 8 weeks of DAA treatment rather than the usual 12-16 for chronic infection, according to another European study at the meeting.

“The idea of targeting acute HCV makes a lot of sense on all levels. If treatment” among patients with HIV “is two-thirds as long and more than two-thirds have persistent infection, there is no reason to hold” off just because of cost, said David Thomas, MD, director of the division of infectious diseases at Johns Hopkins University, Baltimore, who moderated the study presentations.


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