Infectious Disease

A optimistic STI take a look at in HIV sufferers might point out a danger for HCV restoration

January 19, 2021

2 min read

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Disclosure:
Cachay reports that he has received research grants from Gilead Sciences and Merck & Co. to his institution and serves on an advisory board for Gilead. In the study you will find all relevant financial information from all other authors.

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A positive STI test may indicate a higher risk of hepatitis C virus reinfection in patients with HIV who are treated with direct-acting antivirals. This emerges from the study results published in the Open Forum Infectious Diseases.

‚ÄúVarious studies have shown that condom-less sexual practices are linked to the transmission and acquisition of HCV in HIV-infected men who have sex with men (MSM). We have previously shown that in the interferon era in San Diego, our HCV reinfection rates in non-[injection drug use (IDU)] HIV-infected MSM were 2.6 times higher than our annual primary HCV infection rates. ” Edward R. Cachay, MD, MAS, Professor of clinical medicine at the University of California, San Diego, said Healio.

Edward R. Cachay

“One of WHO’s critical targets for HCV elimination by 2030 – a 90% reduction in HCV incidence – could be impacted if HCV reinfection rates were unchanged or higher than those seen in the interferon era,” said Cachay.

Cachay said it is important to identify potential interventions that can help healthcare providers identify individuals at risk for non-IDU HCV recovery associated with non-IDU behaviors.

“This could help us design and test interventions that are more targeted and hopefully less costly to reduce the risk behavior associated with HCV reinfection,” he said.

Cachay and colleagues looked at an observational cohort of people living with HIV (PLWH) who were treated with DAAs between 2014 and July 2019, achieved SVR, and had at least one subsequent measurement of HCV viral load. According to the study, they looked at whether screening for STIs and substance use during the pre-SVR period could identify patients at higher risk of re-infection.

Eight of the 200 PLWH in the study were re-infected with HCV after a median time of 26 weeks after reaching SVR, according to the results. Cachay and colleagues reported that the observed rate of HCV reinfection was highest in MSM IDU (4.63 / 100 person-years follow-up) and in people aged 30 to 39 years (6.8 / 100 person-years follow-up).

They found that a positive gonorrhea-chlamydial nucleic acid amplification test during the pre-SVR period was a predictor of HCV reinfection.

Despite a small cohort size, Cachay said, the results “provide objective evidence that a positive STI test may be a clinical surrogate marker of persistently high risk sexual behavior and risk of HCV recovery.”

“Our finding should be explored in larger and more diverse treatment cohorts,” he said. “Still, we suggest that the finding is clinically meaningful and that those who test positive for gonorrhea or chlamydia prior to SVR should be monitored more closely and considered at a higher risk for HCV reinfection.”

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