title: Multiple hepatitis C virus (HCV) reinfections in HIV-positive men who have sex with men: no influence of HCV genotype switch or interleukin-28B genotype on spontaneous clearance.
abstract: OBJECTIVE
  The incidence of sexually transmitted hepatitis C virus (HCV) reinfection is on the rise in HIV-infected men who have sex with men (MSM). Data on natural history of acute hepatitis C and possible factors associated with spontaneous clearance are limited. The aim of this study was to analyse the outcome of HCV reinfections in HIV-positive MSM.
  
  
  METHODS
  A retrospective analysis was carried out on patients with more than one sexually acquired HCV infection who were diagnosed at four major German HIV and hepatitis care centres. Reinfection was defined by genotype or phylogenetic clade switch, detectable HCV RNA after a sustained virological response (SVR) or after spontaneous clearance (SC).
  
  
  RESULTS
  In total, 48 HIV-positive MSM were identified with HCV reinfection, among them 11 with a third episode and one patient with four episodes. At the first episode, 43 and five patients had an SVR and SC, respectively. The second episode was accompanied by a genotype switch in 29 patients (60%). Whereas 30 and nine patients showed an SVR and SC, respectively, eight patients developed chronic hepatitis. Neither HCV genotype switch nor interleukin-28B genotype was associated with SC. However, SC rates at the second episode were higher for patients with SC at the first episode compared with patients without SC (60 vs. 14%, respectively; P = 0.03). Two patients with SC at the first episode were reinfected with the same genotype.
  
  
  CONCLUSIONS
  Multiple reinfections in HIV-infected MSM do occur, with or without genotype switch, and with prior SC of previous episodes. In this large case series, except for SC at the first episode, no factor was of value in clinical decision-making for early therapeutic intervention in acute HCV reinfection.
authors.affiliation: Medical Center for Infectious Diseases, Berlin, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Ingiliz
authors.forename: I
authors.initials: I
authors.lastname: Krznaric
authors.forename: H-J
authors.initials: HJ
authors.lastname: Stellbrink
authors.forename: G
authors.initials: G
authors.lastname: Knecht
authors.forename: T
authors.initials: T
authors.lastname: Lutz
authors.forename: C
authors.initials: C
authors.lastname: Noah
authors.forename: H
authors.initials: H
authors.lastname: Stocker
authors.forename: M
authors.initials: M
authors.lastname: Obermeier
authors.forename: S
authors.initials: S
authors.lastname: Dupke
authors.forename: C
authors.initials: C
authors.lastname: Boesecke
authors.forename: J K
authors.initials: JK
authors.lastname: Rockstroh
authors.forename: A
authors.initials: A
authors.lastname: Baumgarten
authors.forename: C
authors.initials: C
authors.lastname: Hoffmann
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000235:genetics*; D000328:Adult; D000704:Analysis of Variance; D060085:Coinfection; D005838:Genotype; D005858:Germany; D015658:HIV Infections; D006526:Hepatitis C / Q000150:complications / Q000235:genetics / Q000821:virology*; D018451:Homosexuality, Male; D006801:Humans; D007372:Interferons; D007378:Interleukins / Q000235:genetics*; D008297:Male; D008875:Middle Aged; D010802:Phylogeny; D020641:Polymorphism, Single Nucleotide; D012367:RNA, Viral / Q000032:analysis; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D055815:Young Adult; D000095022:Interferon Lambda
chemical_list: D007372:Interferons; D007378:Interleukins; D012367:RNA, Viral; C000624353:interferon-lambda, human; D000095022:Interferon Lambda
keywords: HIV/HCV coinfection; IL-28B; reinfection; spontaneous clearance