Barcelona 2013
Barcelona 2013
Abstract book - Abstract - 141
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Abstract #141  -  E-Posters English
  50.88: E-Posters English (Poster) on Sunday   in  Chaired by
  Presenting Author:   Dr. Jorge Valencia La Rosa - Hospital Universitario de la Princesa, Spain
  Additional Authors:  Dr. Jordi Casabona, Sra Cristina Sanclemente, Dra. Anna  Esteve, Dra. Victoria Gonzalez, Grupo HIVITS TS,  
The transmission of HCV happens mostly across percutaneous exposure to blood. The role of the sexual transmission has not been well defined. In the last years HCV cases due to sexual transmission in HIV-infected MSM have been described more frequently in some parts of Europe, USA and Australia. We conducted a description of the clinical-epidemiological characteristics and evolution of the cases of HCV acute infection seen in our Hospital.
Method / Issue:
Descriptive study of HIV-infected patients seen in our clinic, who showed HCV antibodies (ELISA) simultaneously with HCV-RNA-positive test (PCR) and that previously had a negative test for antibody, without reporting injection drug use. Period of study: August 2011 to February 2013.
Results / Comments:
We have diagnosed six cases. Age: 40.2±6.22 yo; length of HIV infection: 9.83±6.17 yr. All reported that in the prior 6 months they had engaged in high-risk behaviors for sexual transmitted infections (STI), including unprotected receptive and insertive anal intercourse, participation in group sex, and/or having sex with multiple partners (>10 sexual partners). Stimulant drug use via intranasal route were common, while none heroin and IDU were used. Unprotected sex often occurred under the influence of drugs or alcohol. Mostly they saw blood on self/partners genitals/anus during sex and shared sex toys. Taking erectile dysfunction medication, unprotected receptive double penetration and fisting were not frequent. The half knew that HCV could to be transmitted by sexual route. Only a patient had sex in several countries with multiples sexual partners out of Spain in prior 3 months. All were on ART and with HIV viral load ≤50 copies/ml. HBV-coinfection: 1/6 (HBs Ag positive, HBe Ag negative and DNA-HBV undetectable); HBs Ab ≤10 UI: 2/6 (33.3 %). Previous STI in the last year: 5/6 (83.3 %). Baseline CD4 count: 686.2±198.3 cells/µL. Median ASAT: 200.6±163 IU/L; median ALAT: 491.8±334.4 IU/l. Median HCV-RNA at presentation: 2.133.293 ± 1.703.605 IU/mL. HCV genotype: G4 3/6 (50 %), G1 3/6 (50 %). Polymorphism of IL28B not favorable in 6/6: rs12979860 (5 CT; 1TT) and rs8099917 (5 TG; 1 GG). Fibroscan® at diagnosis: F2 3/6 (50 %), F0 (1), F1 (1), F3 (1). There was a trend toward decrease of the grade of fibrosis measured for Fibroscan® after the acute phase of the hepatitis. No patient showed jaundice as a clinical presentation. During the evolution nobody presented decline ≥2 log of HCV-PCR at 1st month of the diagnosis, neither on the 3rd month spontaneous viral clearance. Two patients have received treatment with pegIFN+ribavirine six months after the diagnosis: one patient showed rapid and early virological response (negative HCV-PCR at 4 and 12 wk of treatment) and the other had decline 2 log of HCV-PCR at 1 st month.
This report suggests that hepatitis C is an emergent STI in HIV-infected MSM population, and it should be a part of the annual screening, especially in those with high risk behavior for STI. It should also be considered in case of sudden increase of transaminases, even without symptoms. The evolution towards chronicity is common in our cases
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