People living with HIV who contract hepatitis C virus (HCV) rarely spontaneously clear the latter virus without treatment, Healio reports. Consequently, researchers advocate changing direct-acting antiviral (DAA) labels to specify that they should be prescribed during the acute, or very early, phase of hep C infection among those coinfected with HIV.

Christoph Boesecke, MD, of the University of Bonn in Germany, presented findings from the PROBE-C study at the 2018 Conference on Retroviruses and Opportunistic Infections (CROI) in Boston.

Christoph Boesecke at CROI 2018 in Boston.

Christoph Boesecke at CROI 2018 in Boston.Benjamin Ryan

PROBE-C is an observational European cohort study of acute hep C infection among HIV-positive individuals. Between 2007 and 2016, investigators documented 465 people with HIV who were newly infected with hep C, had at least 12 months of follow-up and lived in Austria, Denmark, France, Germany, Great Britain, Italy, the Netherlands, Spain and Switzerland.

Ninety-eight percent of the cohort was male, and the median age was 41. The main routes of transmission of hep C were sex between men (98.9 percent) and injection drug use (1.1 percent). A total of 78.3 percent of the cohort had genotype 1 of hep C, 2.6 percent had genotype 3 and 18.6 percent had genotype 4.

The median baseline hep C viral load was 230,000. The median baseline CD4 count was 574. Ninety-two percent of all individuals were on antiretroviral treatment for HIV, and 91 percent had a fully suppressed HIV viral load (below 200) at the baseline. The median maximum ALT liver enzyme level was 445.

Individuals’ acute hep C infection resolved spontaneously in just 11.8 percent of the cases. A total of 69.9 percent of the cohort members began treatment for hep C within 48 weeks of being diagnosed with acute HCV, including 13.1 percent who began DAA treatment within 24 weeks of such a diagnosis. Overall, 75.7 percent of those treated achieved a sustained virologic response 12 weeks after completing therapy (SVR12, considered a cure).

Eleven percent of the overall cohort was cured and then reinfected.

The researchers found no significant association between spontaneous clearance of hep C during acute infection and an individual’s risk factor for hep C transmission, hep C genotype, viral load at baseline or any parameters related to their ALT level or HIV infection. Investigators did note, however, that those who saw their HCV viral load fall by more than two powers of 10 (a 2-log decline) during the first four weeks after receiving a diagnosis of acute hep C were 1,115-fold more likely to spontaneously clear that virus than those who did not see such a decline.

To read the conference abstract, click here.