Methods: We used the HIV Atlanta Veterans Affairs Cohort Study (HAVACS) to examine the incident rate (IR) of acute HCV infections during the period of 01 January 2013 to 31 December 2013 (pre-DAA era) and in the post-DAA era (01 January 2017 to 31 December 2017). Acute HCV infection was identified using HCV seroconversion or HCV viremia with a negative HCV antibody. We also describe the demographic, clinical characteristics, and virologic outcomes of acute HCV infection cases observed since 2014.
Results: In the pre-DAA era, 56 cases of acute HCV were seen among 1378 persons (IR: 40.6 per 1000). In the post-DAA era, 29 cases were seen among 1433 persons (IR: 20.2 per 1000). HAVACS persons seen in 2017 were 52% less likely to be diagnosed with acute HCV infection than those seen in 2013. Of the 7 acute HCV cases examined in detail, the median age is 41 years (range 33-60 years). All cases were male and African American race. Two persons had active IV drug use in addition to unprotected anal intercourse as a risk factor for HCV infection. The median CD4 just prior to HCV infection was 753 cells/cm2 (range: 590-1,046 cells/cm2) . One person had a detectable HIV viral load (527 copies/mL) just prior to HCV infection while the other 6 persons had undetectable HIV viral loads. The peak AST ranged from 147-1256 IU/L (median: 798 IU/L) while the peak ALT ranged from 171-1530 IU/L (median: 855 IU/L). The median total bilirubin is 3.5 mg/dL. One person spontaneously cleared his HCV infection, 2 were treated with DAA therapy, and the other 4 are under active monitoring.
Conclusion: Acute HCV infections have significantly decreased in HIV infected persons in the DAA era. However, acute HCV infections can cause severe transaminitis and jaundice. More work is needed to prevent HCV infections in HIV infected persons.
E. J. Cartwright,
J. Guest, None