HIV ‐positive men who have sex with men are at high risk of development of significant liver fibrosis after an episode of acute hepatitis C

Summary Acute hepatitis C virus infection remains a major health concern in human immunodeficiency virus(HIV)‐infected men who have sex with men (MSM). New direct‐acting antiviral agent (DAA) combination therapy has not yet been approved for the treatment for acute hepatitis C virus(HCV), thereby potentially causing deferral ofHCVtreatment. Therefore, we aimed to study the course of liver disease after an episode of acuteHCV. This study is a retrospective single‐centre cohort ofHIV‐positiveMSMwith acuteHCVinfection. Liver fibrosis was estimated by Fibroscan®and Fibrotest®. Liver‐related and non‐liver‐related outcomes were documented. Overall 213 episodes of acuteHCVinfection in 178 men were documented. Median follow‐up for all included patients was 38.7 months. SpontaneousHCVclearance was found in 10.8% of patients, which was significantly associated with older age, lowerHCV RNAlevels, and higherALTlevels upon initial acuteHCVdiagnosis. Treatment with interferon‐based therapy was initiated in 86.3% of cases, resulting in a sustained virological response(SVR) rate of 70.7%. After 3 years’ follow‐up, significant liver fibrosis ofMETAVIRF2 stage or higher was found in 39.4% of patients after first acuteHCVdiagnosis. Higher age, physician‐declared alcoholism, and nonresponse to acuteHCVtherapy were independently associated with higher fibrosis stages. Ten patients died during the observation period (IR1.4/100 patient‐years) and four during interferon treatment. Significant liver fibrosis is a common finding inHIV‐positiveMSMfollowing acuteHCVinfection despite high treatment uptake and cure rates, suggesting the need for close liver disease monitoring particularly ifHCVtreatment is deferred.