2225. Acute Hepatitis C Virus Infections in HIV-Infected Persons in the Era of Direct-Acting Antiviral Therapy

Abstract

BackgroundAcute hepatitis C (HCV) infection can be sexually transmitted in HIV-infected men who have sex with men (MSM). Since 2014, direct-acting antivirals (DAA) have successfully cured many persons with chronic HCV infection. We examined the incidence of acute HCV infection in HIV-infected persons before and after the widespread use of DAA therapy.MethodsWe used the HIV Atlanta Veterans Affairs Cohort Study (HAVACS) to examine the incident rate (IR) of acute HCV infections during the period of 01 January 2013 to 31 December 2013 (pre-DAA era) and in the post-DAA era (January 1, 2017 to December 31, 2017). Acute HCV infection was identified using HCV seroconversion or HCV viremia with a negative HCV antibody. We also describe the demographic, clinical characteristics, and virologic outcomes of acute HCV infection cases observed since 2014.ResultsIn the pre-DAA era, 56 cases of acute HCV were seen among 1,378 persons (IR: 40.6 per 1000). In the post-DAA era, 29 cases were seen among 1,433 persons (IR: 20.2 per 1,000). HAVACS persons seen in 2017 were 52% less likely to be diagnosed with acute HCV infection than those seen in 2013. Of the seven acute HCV cases examined in detail, the median age is 41 years (range 33–60 years). All cases were male and African American race. Two persons had active IV drug use in addition to unprotected anal intercourse as a risk factor for HCV infection. The median CD4 just prior to HCV infection was 753 cells/cm2 (range: 590–1,046 cells/cm2). One person had a detectable HIV viral load (527 copies/mL) just prior to HCV infection while the other 6 persons had undetectable HIV viral loads. The peak AST ranged from 147 to 1,256 IU/L (median: 798 IU/L) while the peak ALT ranged from 171 to 1,530 IU/L (median: 855 IU/L). The median total bilirubin is 3.5 mg/dL. One person spontaneously cleared his HCV infection, two were treated with DAA therapy, and the other four are under active monitoring.ConclusionAcute HCV infections have significantly decreased in HIV-infected persons in the DAA era. However, acute HCV infections can cause severe transaminitis and jaundice. More work is needed to prevent HCV infections in HIV-infected persons.Disclosures All authors: No reported disclosures.