Spontaneous Clearance of the Hepatitis C Virus Among Men Who Have Sex With Men
Clin Infect Dis. (2015) 61 (9): 1381-1388
Eric C. Seaberg, Mallory D. Witt, Lisa P. Jacobson, Roger Detels, Charles R. Rinaldo, Joseph B. Margolick, Stephen Young, John P. Phair, and Chloe L. Thio
1Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
2David Geffen School of Medicine, University of California–Los Angeles
3Los Angeles Biomedical Research Institute at Harbor University of California–Los Angeles, Torrance
4Department of Epidemiology, University of California–Los Angeles, School of Public Health, California
5Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
6Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
7Department of Pathology, University of New Mexico HSC, Albuquerque
8Feinberg School of Medicine, Northwestern University, Chicago, Illinois
9Department of Medicine, Johns Hopkins University, Baltimore, Maryland
Correspondence: Eric C. Seaberg, PhD, MPH, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Rm E-7634, Baltimore, MD 21205 (email@example.com).
The probability of spontaneous hepatitis C virus (HCV) clearance ranges from 11% to 49%. Our previous cross-sectional study suggests that mode of acquisition explains some of this heterogeneity. We performed this prospective study to determine factors associated with spontaneous HCV clearance among men who have sex with men (MSM).
A mixture-cure model was used to evaluate the probability of spontaneous HCV clearance among 101 MSM in the Multicenter AIDS Cohort Study with acute HCV infection between 1984 and 2012.
Spontaneous HCV clearance occurred in 46% of MSM (49% in non-injection drug users [IDUs] and 23% in IDUs). In the multivariable analysis, age <30 years (clearance ratio [CR] = 2.43; 95% confidence interval [CI], 1.53–3.87) and being human immunodeficiency virus (HIV) uninfected (CR = 2.97; 95% CI, 1.98–4.46) were independently associated with spontaneous clearance. Among men aged ≥30 years, being HIV uninfected, not having unprotected anal intercourse, older age, and being on highly active antiretroviral therapy were independently associated with higher clearance. The interferon lambda rs12979860 single nucleotide polymorphism (SNP) was not associated with spontaneous clearance among the 88 MSM who were not active IDUs (CR = 0.74; 95% CI, .46–1.21 for CC vs CT/TT genotype).
The high probability of spontaneous HCV clearance together with the lack of an association between the rs12979860 SNP and spontaneous clearance among MSM who do not use injection drugs suggests that the immune mechanisms involved with a successful response to acute HCV differ by mode of virus acquisition. Understanding potential mechanistic differences could be important for HCV vaccine development.