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CROI 2007: HCV May Be Sexually Transmitted in HIV Negative as Well as HIV Positive Men

In recent years, outbreaks of apparently sexually transmitted hepatitis C virus (HCV) infection have been reported in London and Brighton in the UK and in a few European cities. In almost all cases, these acute HCV infections have occurred in HIV positive gay and bisexual men.

At the 14th Conference on Retroviruses and Opportunistic Infections in Los Angelesthis week, however, researchers from Brighton reported that HCV screening of all men attending a large sexually transmitted disease (STD) clinic revealed that about one-third of men with incident HCV infection were either HIV negative or of unknown HIV serostatus.

Such cases may have gone unnoticed in the past because HIV negative men who have sex with men (MSM) typically do not receive routine HCV antibody screening – unlike HIV positive individuals, for whom treatment guidelines recommend HCV screening and regular liver enzyme monitoring to detect antiretroviral drug toxicity. Due to the high HCV infection rate in Brighton, all MSM attending the STD/HIV clinic since 2000 have been tested for HCV, regardless of HIV status.

Results

• Out of a total of clinic population of 7169 patients, 3907 had at least one negative HCV antibody test.
• Men who reported current or past injection drug use were excluded from analysis.
• Among those with an initial negative HCV test, 25 men were newly diagnosed with HCV during 2000-2006:
  • 16 HIV positive;
  • 5 HIV negative;
  • 4 of unknown HIV serostatus.
• Of the 9 men who initially were HIV negative or of unknown serostatus, 8 went on to test HIV positive.
• HIV positive men were over 13 times more likely to have an incident HCV diagnosis compared with HIV negative men (adjusted risk ratio 13.59; P = 0.0001)
• Men of unknown HIV serostatus had a similar HCV infection rate to that of HIV negative men (adjusted risk ratio 1.92; P = non-significant).
• Overall, the rate of incident HCV diagnosis (among men of any HIV serostatus) increased over time:
  • The rate rose from none during 2000-2002 to nearly 4 cases per 1000 person-years in 2006.
  • From 2002 on, the incidence rate rose by 56% per year.
• Incident HCV diagnosis was associated with several risk factors, in agreement with past reports:
  • fisting;
  • unprotected anal intercourse;
  • multiple sex partners;
  • infection with other STDs;
  • recreational non-injection drug use.

Conclusion

The researchers concluded that, “There has been, and continues to be, a significant increase in acute HCV in MSM. Contrary to current evidence, this phenomenon is not exclusively in MSM with HIV.”

They added that their findings suggest that all gay and bisexual men attending STD clinics should be routinely screened for HCV.

3/2/07

Reference

M Fisher, D Richardson, C Sabin. Acute Hepatitis C in Men Who Have Sex With Men Is Not Confined to Those Infected with HIV, and Their Number Continues to Increase. 14th Conference on Retroviruses and Opportunistic Infections. Los Angeles, February 25-28, 2007. Abstract 130.