Prevalence of Co-Infection and Reinfection by Hepatitis C in People Living With Hiv in São Paulo, Brazil

Hepatitis C virus (HCV) infection has a higher prevalence (depending on the population, up to 25–30%) and greater severity among people living with HIV (PLHIV). To evaluate the prevalence of HCV infection and reinfection among PLHIV and to describe clinical forms and treatment responses. This is a retrospective study evaluating 605 PLHIV co-infected with HIV/HCV between 2020–21, in São Paulo, Brazil (public and private services), all under regular follow-up every 6 months with the same physician. Participants were analyzed regarding clinical, epidemiological, laboratory, and outcome data related to HCV. A total of 605 PLHIV were evaluated; 34 83% were male, with a mean age of 48 years. Sexual transmission occurred in 38 (93%) and drug use in 3 (7%). An undetectable HIV viral load was found in 36 (88%). Among participants, 41 (6.8%) were co-infected with HCV and 3 developed reinfection, with a reinfection rate of 7.3%. The clinical forms identified were: chronic hepatitis – 24 (58%), acute – 11 (27%) including 3 reinfections, and anti-HCV positive (antibodies to HCV) with undetectable HCV RNA in 6 participants (15%). Genotyping was performed in 29 patients (71%), 3 of whom presented 2 genotypes due to reinfection. The genotypes (GN) found were GN1: 21, GN2: 2, GN3: 3, and GN4: 6 participants. Transient hepatic elastography by FibroScan was performed in 15 participants (36.5%); among those with chronic hepatitis, the Metavir fibrosis stages were F0: 4, F1: 2, F2: 4, F3: 2, and F4: 3 participants. Twenty-nine participants received treatment. Sustained virologic response (SVR) occurred in 25 (86%), with the following regimens: sofosbuvir/daclatasvir (10), sofosbuvir/daclatasvir/ribavirin (5), sofosbuvir/ledipasvir (2), sofosbuvir/velpatasvir (2), and sofosbuvir/ribavirin (1). For 5 participants, antiviral data were unavailable. Four patients (with cirrhosis, chronic kidney disease, and reinfection) experienced relapse after first-line therapy. After retreatment with glecaprevir + pibrentasvir, all achieved SVR. Anti-HCV reactive and HCV RNA undetectable were seen in 6 cases; acute hepatitis with spontaneous resolution in 1; and 5 participants were untreated due to loss to follow-up. We found a lower prevalence of HCV infection among PLHIV compared with the literature, a high prevalence of acute forms (likely due to early diagnosis through semiannual anti-HCV testing), predominance of genotypes 1 and 4, 22% with Metavir F3–F4 fibrosis, and SVR in all patients after the second treatment course.