Increases in acute hepatitis C (HCV) incidence across Europe: which regions and patient groups are affected?

Background : In the last decade, several outbreaks of sexually acquired acute HCV have been described in men who have sex with men (MSM) infected with HIV in Australia, Europe, and North America. The aims of this study were to determine the incidence of acute HCV within the large EuroSIDA cohort and to explore possible regional differences throughout Europe and in different HIV transmission risk groups. Methods : Baseline was defined as 1st Jan of 2002 or entry into EuroSIDA, whichever comes later. All patients from EuroSIDA who were HCV antibody-negative at baseline and had at least 2 HCV antibody test results available were included into the study. HCV seroconversion was defined as change from negative to positive HCV-antibody test within the observation period from 2002 onwards. Follow-up was counted from baseline to HCV antibody positivity for seroconverters and to the last HCV antibody-negative test result for those that did not seroconvert for HCV. Poisson regression analyses were performed to identify predictive factors for HCV seroconversion. Results : A total of 150 HCV seroconversions (95 [63.3%] in MSM) occurred in 4295 patients during 18,928 person years of follow-up (PYFU), overall incidence of 0.79 acute infections per 100 PYFU (95% CI: 0.67-0.92) (see figure). The incidence of HCV seroconversions increased from 0.47 (CI: 0.19–0.74) in 2002 to 2.34 (CI: 1.24-3.44) in 2010. Similar patterns were observed across all European regions (p=0.89, test for interaction). In multivariate analysis, IDU was associated with a higher incidence rate ratio (IRR) than MSM: 4.59 (2.40-8.80; p<0.0001), South and East Europe both had higher IRR compared to Western Europe, respectively (1.98 [1.12-3.49]; p=0.018 and 2.41 [1.41-4.12]; p=0.0014). Calendar year per 2 years was also associated with a higher IRR (1.29 [1.19-1.39]; p<0.0001). Conclusion : The incidence of acute HCV within EuroSIDA increased over time. Although, the incidence of seroconversion was 54% higher in MSM than in heterosexuals, IDUs had the highest incidence of HCV seroconversion. Rising incidences can be found in all European regions highlighting the need for increased prevention efforts in all European countries. (Published: 11 November 2012) Citation: Abstracts of the Eleventh International Congress on Drug Therapy in HIV Infection Rockstroh J et al. Journal of the International AIDS Society 2012, 15 (Suppl 4):18116 http://www.jiasociety.org/index.php/jias/article/view/18116 | http://dx.doi.org/10.7448/IAS.15.6.18116