Over a third of HIV-positive gay men develop significant liver fibrosis after an episode of acute hepatitis C virus (HCV) infection, German investigators report in the Journal of Viral Hepatitis. Over three years of follow-up, 39% of individuals developed fibrosis stage F2 or higher. Risk factors included older age, alcoholism and non-response to therapy based on interferon during acute infection.

Highly effective HCV therapy using direct-acting antiviral agents (DAAs) is now available and can achieve a cure in almost all people. However, it is not currently indicated for the treatment of acute infection. Moreover, since the introduction of DAAs, the proportion of European patients with acute HCV infection opting for therapy with older interferon-based treatments has dropped dramatically, potentially increasing the risk of significant fibrosis over time.

“We observed a high rate of significant liver fibrosis…and even cirrhosis (11.6%),” comment the investigators. “We interpret this finding as an effect of acute HCV on the liver, and the short HCV infection duration in this HIV-infected population was apparently sufficient to induce significant liver damage.”

Globally, between 5 and 15% of HIV-positive people have co-infection with HCV. There are well-established epidemics of HCV among HIV-positive gay and other men who have sex with men (MSM) in Europe, Australia and the US. HCV-related liver disease is now a major cause of illness and death in people with co-infection.

“Older men, chronic drinkers, and those with uncontrolled HCV RNA replication are at particularly high risk of fibrosis progression,” conclude the authors. “This subgroup could warrant closer monitoring by non-invasive markers of fibrosis and should be considered for early treatment.”

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