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Title
High rate of hepatitis C and reinfection after direct-acting antiviral treatment among men-who-have-sex-with-men living with HIV in Bangkok, Thailand
Presenter
Pathariya Promsena
Authors
P. Promsena1,2, F. Ocampo1, C.P. Sacdalan1,2, M. Paudel3,4, S. Pinyakorn3,4, D.J. Colby3,4, N. Ratnaratorn1, K. Poltavee1, N. Chomchey1, S. Sriplienchan1, T. Wansom5, N. Phanuphak6, S. Vasan3,4, D. Hsu3,4, L. Trautmann3,4
Institutions
1SEARCH Research Foundation, Bangkok, Thailand, 2Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, 3U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States, 4Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States, 5Dreamlopments Foundation, Bangkok, Thailand, 6Institute of HIV Research and Innovation, Bangkok, Thailand

BACKGROUND: Hepatitis C virus(HCV) infection has been increasing among men-who-have-sex-with-men(MSM) living with HIV. Direct-acting antivirals(DAAs) are associated with high HCV cure rates, but re-infection can occur if exposed to HCV again. This analysis describes HCV incidence, treatment outcomes, and reinfection rates in an early-treated acute HIV infection(AHI) cohort in Thailand.
METHODS: SEARCH010/RV254 enrolls participants with AHI. HCV antibody was measured at enrolment and annually. Participants with HCV viremia initiated DAAs. Sustained virological response(SVR) was assessed > 12 weeks after treatment completion. HCV RNA was monitored annually in participants with HCV clearance(spontaneous or SVR). HCV incidence rates and reinfection rates with 95% confidence intervals(CI) per 100 person-years of follow-up(PYFU) were calculated using the exact method.
RESULTS: Between 2009-2022, 694 HCV seronegative participants were enrolled. Most(92.5%) were MSM with median age 26.0 years(IQR 23.0-32.0). During total 3,678 PYFU, 98(14.1%) acquired HCV infection; incidence rate was 2.7/100 PYFU(95% CI 2.2-3.3). Median time to HCV diagnosis after AHI was 3.0 years(IQR 0.5-5.5). Differences in baseline demographic characteristics between participants who developed HCV and who remained HCV negative were not statistically significant(Table 1). Among 98 incident cases, the most common HCV genotype was 1/1a(N=70, 93.3%). Sofosbuvir/ledipasvir(56.8%) and sofosbuvir/velpatasvir(33.8%) were the most frequently initiated DAAs. Of 72 participants who completed treatment, 68(94.4%) achieved SVR. Additionally, 10 participants spontaneously cleared HCV RNA. HCV reinfection occurred in 9/78(11.5%) during 106.6 total PYFU after clearance; at a rate of 8.5/100 PYFU(95% CI 3.9-16.0). The median time to reinfection was 1.0 years(IQR 0.9-2.5). 3/10(30.0%) reinfections occurred after spontaneous clearance and 6/68(8.8%) after SVR.

table 1 HCV IAS abstract.png
CONCLUSIONS: In this early-treated AHI cohort of Thai MSM, there is high incidence of HCV infection. Treatment with DAAs resulted in high SVR rates, but HCV reinfection was common. Post-clearance follow-up with harm reduction measures is essential to identify and minimize HCV reinfection.