Rapid decline of anti-HCV antibodies following early treatment of incident HCV infections in HIV-infected MSM. HIV Medicine
Aebi-Popp et al. investigated HCV antibody level dynamics following an incident HCV infection in HIV-infected MSM with different clinical outcomes: treatment-induced sustained virological response (SVR), spontaneous clearance, and untreated HCV infection progressing to chronic infection.
At baseline, median HCV antibody levels were similar in the three groups. Over 3 years of follow-up, SVR was associated with a more pronounced decrease in anti-HCV levels compared with spontaneous clearance and untreated infection [median decline 71% [interquartile range (IQR: 43–87%), 38% (IQR: 29–60%) and 12% (IQR: 9–22%), respectively; P < 0.001]. Seroreversions occurred in five of 33 (15%) patients with SVR and in one of 12 (8%) with spontaneous clearance. A shorter delay between time of infection and treatment start correlated with higher rates of decline in antibody levels. Seven (16%) patients with treatment-induced or spontaneous HCV clearance experienced a reinfection, and all but one had detectable HCV antibodies before reinfection.
In conclusion, SVR was associated with a more pronounced decline in anti-HCV antibody levels and with a higher frequency of seroreversions compared with spontaneous clearance or untreated replicating HCV infection among HIV-infected MSM with incident HCV infections. The high rate of reinfections in patients with detectable HCV antibodies before reinfection suggest that detectable HCV antibodies do not confer protection against reinfection.