HIV-positive men who have sex with men are at high risk of development of significant liver fibrosis after an episode of acute hepatitis C

J Viral Hepat. 2017 Oct;24(10):832-839. doi: 10.1111/jvh.12707. Epub 2017 Apr 25.


Acute hepatitis C virus infection remains a major health concern in human immunodeficiency virus(HIV)-infected men who have sex with men (MSM). New direct-acting antiviral agent (DAA) combination therapy has not yet been approved for the treatment for acute hepatitis C virus(HCV), thereby potentially causing deferral of HCV treatment. Therefore, we aimed to study the course of liver disease after an episode of acute HCV. This study is a retrospective single-centre cohort of HIV-positive MSM with acute HCV infection. Liver fibrosis was estimated by Fibroscan® and Fibrotest® . Liver-related and non-liver-related outcomes were documented. Overall 213 episodes of acute HCV infection in 178 men were documented. Median follow-up for all included patients was 38.7 months. Spontaneous HCV clearance was found in 10.8% of patients, which was significantly associated with older age, lower HCV RNA levels, and higher ALT levels upon initial acute HCV diagnosis. Treatment with interferon-based therapy was initiated in 86.3% of cases, resulting in a sustained virological response(SVR) rate of 70.7%. After 3 years' follow-up, significant liver fibrosis of METAVIR F2 stage or higher was found in 39.4% of patients after first acute HCV diagnosis. Higher age, physician-declared alcoholism, and nonresponse to acute HCV therapy were independently associated with higher fibrosis stages. Ten patients died during the observation period (IR 1.4/100 patient-years) and four during interferon treatment. Significant liver fibrosis is a common finding in HIV-positive MSM following acute HCV infection despite high treatment uptake and cure rates, suggesting the need for close liver disease monitoring particularly if HCV treatment is deferred.

Keywords: cirrhosis; fibrosis progression; human immunodeficiency virus/hepatitis C virus coinfection; interferon; spontaneous clearance; sustained virological response.

MeSH terms

  • Adult
  • Antiviral Agents / therapeutic use
  • Coinfection*
  • Female
  • Genotype
  • HIV Infections / virology*
  • Hepacivirus / genetics
  • Hepatitis C / complications*
  • Hepatitis C / diagnosis
  • Hepatitis C / virology*
  • Homosexuality, Male*
  • Humans
  • Liver Cirrhosis / diagnosis
  • Liver Cirrhosis / epidemiology*
  • Liver Cirrhosis / etiology*
  • Liver Cirrhosis / mortality
  • Male
  • Middle Aged
  • Morbidity
  • Mortality
  • Severity of Illness Index
  • Sustained Virologic Response
  • Viral Load


  • Antiviral Agents