Acute hepatitis C in HIV-1 infected Japanese Cohort: single center retrospective cohort study

Abstract

Objectives: HCV co-infection is a poor prognostic factor in HIV-1-infected patients. Although the number of newly reported patients who show seroconversion is increasing, the clinical features are still unclear, especially in Asian countries.

Design: A single-center retrospective cohort study of patients diagnosed between 2001-2012.

Methods: Acute hepatitis C (AHC) was diagnosed upon detection of high serum ALT (>100 IU) followed by anti-HCV seroconversion. Clinical characteristics, HIV-1-related immunological status and IL-28B genotypes (rs12979860, rs8099917) were collected. We compared these variables between patients with and without spontaneous clearance of HCV and between responders and non-responders to treatment with pegylated interferon (PEG-IFN) plus ribavirin.

Results: Thirty-five patients were diagnosed with AHC during the study period. The majority (96.9%) were MSM. Three were lost to follow-up. Seventy-five percent of patients with AHC (24/32) were asymptomatic and found incidentally to have high serum ALT. Compared to those who did not show spontaneous clearance, patients with spontaneous HCV viral clearance showed more symptoms and more severe abnormalities related to acute hepatitis. Spontaneous clearance was seen in 4 out of 28 patients with CC+TT genotype, but not in 6 patients with IL-28B CT+TG genotype. PEG-IFN plus ribavirin treatment was initiated in 12 out of 28 cases without spontaneous clearance. The sustained virological response rate was high (81.8%, 9/11), even in cases with CT+TG genotype infected with HCV genotype 1b (SVR 2/2).

Conclusions: Careful attention to AHC is needed in HIV-1-infected MSM. Early diagnosis and PEG-IFN plus ribavirin treatment should be considered for AHC cases.

Figure 1. Patient enrollment process.

Acute hepatitis C (AHC) was defined as elevation of alanine transaminase (ALT) >100 IU/L accompanied by seroconversion of anti-hepatitis C virus (HCV) antibody. Three patients could not be followed up for 1 year after diagnosis and were excluded from further analysis. HCV cleared spontaneously in 4 cases. PEG-IFN plus RBV treatment was initiated within 1 year of diagnosis of AHC in 12 out of 28 patients who did not show spontaneous clearance. One patient with missing treatment data following transfer to another clinic about two weeks after initiation of IFN plus RBV, was excluded from analysis related to the effect of PEG-IFN plus RBV. PEG-IFN: pegylated interferon, RBV: ribavirin.

Figure 2. Histological findings in needle liver biopsy specimen from the patient who showed null-response (Table 3).

The pre-treatment biopsy specimen obtained at 13 weeks after AHC diagnosis showed stage 2 fibrosis (F2) according to the classification of chronic hepatitis C (New Inuyama Classification). (A and B) Formation of bridging fibrosis by fibrous and cellular expansion in the portal tract. (C) Magnified view showing centrilobular piece-meal necrosis (green arrow), acid folic body (yellow arrow) and spotty necrosis (red arrow). (A) Hematoxylin-eosin stain, x100, (B) Silver impregnation stain, x100, (C) Hematoxylin-eosin stain, x400. PEG-IFN: pegylated interferon, RBV: ribavirin, AHC: acute C hepatitis.