London epidemic of sexually transmitted hepatitis C

Two studies indicate an epidemic of acute hepatitis C in London, transmitted sexually among HIV-positive men who engage in high-risk, unprotected sexual activities with other men. A high percentrage of individuals spontaneously cleared the HCV infection.

Mark Nelson et al at the Chelsea and Westminster Hospital report: “In recent months we have seen an epidemic of acute hepatitis C, probably sexually transmitted, with individuals reporting unsafe sex and a higher rate of recent syphilis infection.” [1]

Fletcher at the Ian Charleson Centre at the Royal Free Hospital says that whereas major risk factors for HCV transmission have been sharing needles for intravenous drug users (IVDUs) and receiving blood and blood products, “recent findings suggest that HCV is being increasingly sexually transmitted, particularly among HIV-positive men who engage in high-risk, unprotected sexual behaviours with other men”. [2]

Six patients (37.5%) spontaneously cleared the infection. The remaining 10 were treated with pegylated interferon alpha-2b in combination with ribavirin. Three patients achieved a significant reduction in HCV RNA after 12 to 24 weeks of treatment.

Nelson and colleagues carried out a prospective evaluation of acute HCV infection between January 1997 and June 2003. Forty-four individuals were identified, 38 in the last 18 months. All were homosexual men and one had a history of recent IVDU. Fifteen were diagnosed with syphilis in the year before HCV seroconversion. Twenty did not receive treatment; 10 of them because they spontaneously seroreverted to PCR-negative. Those who spontaneously seroreverted to PCR-negative were more likely to have a CD4 count >500 (70% vs 30%) and had higher ALT at diagnosis. Tweny-four patients were treated, 15 of them have finished treatment and nine continue. One received interferon/ribavirin, one pegylated interferon alone and the rest pegylated interferon/ribavirin. Of the 15, 10 have been successfully treated to the point of testing PCR-negative, and treatment failed for five (one due to toxicity, four because of lack of response). The researchers report that treatment response to interferon was lower in the subjects than in the HIV-negative population.