Sexual transmission is associated with spontaneous HCV clearance in HIV-infected patients☆
Received 15 February 2008; received in revised form 17 March 2008; accepted 5 April 2008. published online 06 May 2008.
Background/Aims
There are conflicting data regarding the incidence and factors implicated in the spontaneous clearance of hepatitis C virus (HCV) after acute infection. The aim of this study was to determine the epidemiological factors that predict the resolution of acute HCV infection without therapy in patients with human immunodeficiency virus (HIV) infection.
Methods
We conducted a retrospective, multivariate analysis of epidemiological data from HIV-infected patients presenting from 2000 to 2007 with evidence of past or present HCV infection. Data were collected from one American and two European HIV treatment clinics. A final cohort of 769 HIV-infected patients referred for treatment with available test results for antibody to HCV, HCV RNA, and hepatitis B surface antigen were included for the analysis. We calculated spontaneous clearance rates based on race, geographical location, gender, transmission risk factors, and hepatitis B virus coinfection.
Results
Patients who admitted to a history of injection drug use spontaneously cleared the HCV infection significantly less often (11.6%) than those in whom sexual transmission was the presumed route of HCV infection (21.9%) (p=0.004). This difference was more pronounced when heterosexual contact as the source of infection was analyzed separately. Multivariate analysis identified heterosexual HCV transmission (OR 2.81, 95% CI 1.55–5.09) and hepatitis B surface antigen carrier status (OR 10.3, 95% CI 4.29–24.73) as independent factors predicting spontaneous HCV clearance. No differences according to gender, race or geographical origin were observed.
Conclusions
In summary, sexual transmission, particularly heterosexual, and hepatitis B virus coinfection were the only factors associated with spontaneous HCV clearance in this HIV-infected population.
1Division of Gastroenterology, Department of Medicine, Wake Forest University Health System, Winston-Salem, NC, USA
2Istituto Malattie Infettive, University of Sassari, Italy
3Infectious Diseases, Hospital Carlos III, Madrid, Spain
4Division of Infectious Disease, Department of Medicine, Wake Forest University Health Sciences, Winston-Salem, NC, USA
Corresponding author.
☆ The authors declare that they do not have anything to disclose regarding funding from industries or conflict of interest with respect to this manuscript.
ABSTRACT