{"id":533,"date":"2015-01-15T11:00:14","date_gmt":"2015-01-15T11:00:14","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=533"},"modified":"2017-08-21T12:04:49","modified_gmt":"2017-08-21T12:04:49","slug":"primary-care-corner-with-geoffrey-modest-md-hepatitis-c-reinfection","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/01\/15\/primary-care-corner-with-geoffrey-modest-md-hepatitis-c-reinfection\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: Hepatitis C Reinfection"},"content":{"rendered":"

By: Dr. Geoffrey Modest\u00a0<\/strong><\/p>\n

A recent article from the Netherlands\u00a0looking at hepatitis C (HCV)\u00a0infection and reinfection in HIV positive MSM (men who have sex with men) sheds some light on the murky subject of HCV\u00a0virology\u00a0(See Clinical Infectious Diseases 2014;59(12):1678\u201385<\/strong>). \u00a0It has been known that anti-HCV antibody titers can decline in both acute and chronic HCV infection and can\u00a0even lead to seroreversion (ie, negative blood test for anti-HCV antibody). In this study, 63 people, who\u00a0were followed a median of 4 years with HCV testing at least annually, seroconverted from\u00a0negative anti-HCV Ab to positive. These men denied injection drug use and “phylogenetic\u00a0analyses of circulating\u00a0HCV strains have revealed the presence of multiple MSM-specific clusters”. The researchers differentiated HCV reinfection (either infection with a different genotype than the initial infection, or at least looking for changes in certain genetic sequences from the initial infection within the same genotype) vs relapse (resurgence of HCV RNA in the blood with the same viral strain). \u00a0Baseline: median\u00a0age at primary HCV infection was 42, 62% were genotype 1a, baseline CD4 count was 495 and nadir 260.<\/p>\n

Results:<\/p>\n

\u00a0–in those who developed an acute HCV infection, median time from first positive viral load (HCV RNA test) to positive antibody (anti-HCV Ab) was 74 days (no different from the timeframe found in non-HIV infected individuals)<\/p>\n

–in the 36 who cleared the HCV RNA (5 cleared HCV spontaneously, 31 by treatment), there was a significant decline in the quantitative anti-HCV Ab levels<\/p>\n

–in the 31 who developed a sustained virologic response (SVR) to HCV\u00a0treatment, 8 developed non-detectable anti-HCV\u00a0Ab, with a cumulative incidence of such seroreversion being 37% within 3 years of seroconversion.<\/p>\n

–18 of these seroreverters became reinfected with HCV (a total of 21 reinfections)\u00a0during follow-up, with an increase in anti-HCV Ab (the peak anti-HCV titers were significantly higher with reinfections)<\/p>\n

–1 treated\u00a0patient\u00a0had 3 reinfections, which showed large increases of anti-HCV titer with each newly positive HCV RNA test.<\/p>\n

–in 17 of 63 people (27%), no anti-HCV\u00a0Ab could be detected 4 months after infection, and ALT levels only showed reinfection in 72% (ie, one needs to check the HCV RNA to reliably detect a reinfection)<\/p>\n

For a recent review of the complex and not completely understood immunologic response to hepatitis C, see here<\/a>.<\/p>\n

So, I bring up this study for a few reasons.<\/p>\n

–HCV\u200b infection is so common (2-3% of people globally, and certainly lots in our health center)<\/p>\n

–this study provides a snapshot of the epidemiology of acute\u00a0HCV infections in a high risk group, since these people had annual hepatitis C measurements, as well as with any signs of hepatitis\u00a0(the study did not include those with chronic HCV)<\/p>\n

–it is important to note that HIV-infected patients, though relatively frequently\u00a0coinfected\u00a0with HCV, do have\u00a0in differences in the immunology of their\u00a0HCV. For example, patients with\u00a0HIV, especially advanced (not represented in above study),\u00a0are more likely to have a false\u00a0negative anti-HCV\u00a0antibody with hep C\u00a0infection (ie, if clinical hepatitis is suspected, you should routinely check a viral load and not just the antibody or rely on\u00a0an\u00a0ALT elevation\u00a0in those with HIV. The same holds for\u00a0those with recent exposure who are\u00a0immunocompetent)<\/p>\n

–people who either spontaneously clear the HCV infection, or respond well to therapy, remain susceptible to reinfection (ie, neither a\u00a0robust neutralizing antibody response associated with spontaneous viral clearance, nor vigorous\u00a0HCV-specific T-cell responses seem to confer reliable long-term immunity from reinfection)<\/p>\n

–at least in HIV-positive MSM, it seems that sexual transmission of\u00a0HCV is pretty common (the data on heterosexual HCV-discordant couples is: a very low rate of sexual transmission, though this\u00a0does slowly increase with number of years of sexual exposure)<\/p>\n

–it seems useful to follow quantitative anti-HCV\u00a0Ab levels as a means to diagnosis HCV reinfection (our lab currently does not report levels, but it should…)\u200b<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

By: Dr. Geoffrey Modest\u00a0 A recent article from the Netherlands\u00a0looking at hepatitis C (HCV)\u00a0infection and reinfection in HIV positive MSM (men who have sex with men) sheds some light on the murky subject of HCV\u00a0virology\u00a0(See Clinical Infectious Diseases 2014;59(12):1678\u201385). \u00a0It has been known that anti-HCV antibody titers can decline in both acute and chronic HCV […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":148,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[14283],"tags":[],"class_list":["post-533","post","type-post","status-publish","format-standard","hentry","category-archive"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/533","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/users\/148"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/comments?post=533"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/533\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/media?parent=533"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/categories?post=533"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/tags?post=533"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}