Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
HIV Med. 2018 Jul;19(6):420-425. doi: 10.1111/hiv.12602. Epub 2018 Mar 24.
Following clearance of incident hepatitis C virus (HCV) infections, HCV antibody levels may decline, resulting in seroreversion. It is unclear to what extent HCV antibody level trajectories differ between patients with treatment-induced sustained virological response (SVR), those with spontaneous clearance and those with untreated replicating HCV infection. We investigated HCV antibody level dynamics in HIV-infected MSM with different clinical outcomes.
We investigated anti-HCV antibody level dynamics following an incident HCV infection in 67 HIV-infected men who have sex with men (MSM) with different clinical outcomes: SVR (n = 33), spontaneous clearance (n = 12), and untreated replicating infection (n = 22). Antibody levels were measured at the time of HCV diagnosis, and at yearly intervals for 3 years thereafter.
At baseline, median HCV antibody levels were similar in the three groups: 13.4, 13.8 and 13.5 sample to cut-off (S/CO) for SVR, spontaneous clearance and untreated infection, respectively. Over 3 years of follow-up, SVR was associated with a more pronounced decrease in anti-HCV levels compared with spontaneous clearance and untreated infection [median decline 71% [interquartile range (IQR: 43-87%), 38% (IQR: 29-60%) and 12% (IQR: 9-22%), respectively; P < 0.001]. Seroreversions occurred in five of 33 (15%) patients with SVR and in one of 12 (8%) with spontaneous clearance. A shorter delay between time of infection and treatment start correlated with higher rates of decline in antibody levels. Seven patients experienced a reinfection.
Treatment-induced HCV clearance was associated with a more pronounced decline in anti-HCV antibody levels and with higher rates of seroreversion compared with spontaneous clearance or untreated replicating HCV infection among HIV-infected MSM with incident HCV infections. Rapid clearance of HCV RNA following early HCV treatment might impair the development of persistent antibody titres.
清除丙型肝炎病毒（HCV）感染后，HCV 抗体水平可能下降，导致血清学转换。尚不清楚治疗诱导的持续病毒学应答（SVR）、自发清除和未经治疗的 HCV 复制感染患者之间 HCV 抗体水平轨迹有何不同。我们研究了不同临床结局的 HIV 感染男男性行为者（MSM）中 HCV 抗体水平的动态变化。
我们研究了 67 例 HIV 感染的男男性行为者（MSM）中不同临床结局的 HCV 感染后 HCV 抗体水平动态变化：SVR（n = 33）、自发清除（n = 12）和未经治疗的复制感染（n = 22）。在 HCV 诊断时以及此后 3 年每年测量一次抗体水平。
在基线时，三组的 HCV 抗体水平中位数相似：SVR、自发清除和未经治疗感染的中位数分别为 13.4、13.8 和 13.5 样本/截止值（S/CO）。在 3 年的随访中，与自发清除和未经治疗感染相比，SVR 与更明显的抗 HCV 水平下降相关[中位数下降分别为 71%（IQR：43-87%）、38%（IQR：29-60%）和 12%（IQR：9-22%）；P < 0.001]。SVR 中有 5 例（15%）和自发清除中有 1 例（8%）发生血清学转换。感染和治疗开始之间的时间间隔越短，抗体水平下降的速度越快。7 例患者发生再感染。
与自发清除或未经治疗的 HCV 复制感染相比，HIV 感染的 MSM 中 HCV 清除与更明显的抗 HCV 抗体水平下降和更高的血清学转换率相关。HCV 治疗后 HCV RNA 的快速清除可能会损害持续抗体滴度的产生。
