Growing Evidence Suggests Hepatitis C Can Be Transmitted Sexually

In a new study, New York City researchers suggest that new hepatitis C virus (HCV) infections found among 74 HIV-infected men who have sex with men were acquired sexually.

In late 2005, Dr. Daniel Fierer, infectious-disease expert at Mount Sinai School of Medicine, and colleagues evaluated two HIV-infected MSM with acute HCV infection suspected of being sexually acquired. They requested referrals of any subsequent such cases.

From October 2005 to December 2010, Mount Sinai evaluated 74 HIV-infected MSM with newly elevated alanine transferase levels, a new positive HCV antibody test and no injection drug use. All reported receptive anal sex and no other typical HCV risk factors, and 91 percent were previously HCV-negative. Median patient age was 39, and median CD4 cell count was 483/microliter (range 66-1,258). Of the men, 81 percent were asymptomatic, and HCV infection was detected solely because of ALT elevation, while 19 percent had jaundice at presentation.

Compared with other HIV-positive MSM who did not have HCV or inject drugs, the men with HCV were 23 times more likely to have had unprotected receptive anal sex with ejaculation of partner and 29 times more likely to have had sex while using methamphetamine. Genetic analysis showed five clusters of closely related HCV variants, indicating transmission through groups of interconnected MSM.

While sexual exposure is usually considered an inefficient mode of HCV transmission, concurrent HIV infection results in elevated HCV viral loads, which are thought to increase infectiousness of sexually acquired HCV, the editorial note says.

Similar reports implicating sexual transmission for HCV among HIV-infected MSM have been made over the last decade, especially in Europe, the authors wrote. However, HIV-positive MSM, "and to some extent their health care providers, are generally not aware that having unprotected receptive sex can result in HCV infection," Fierer said in a statement. "Our study suggests that HIV-infected MSM should take steps to protect themselves and others by using condoms and by avoiding crystal methamphetamine."

"HIV-infected patients should be counseled and reminded that unprotected sex between HIV-infected partners can transmit other infections, including HCV," the study's editorial states. Newly HIV-positive MSM should be screened for HCV, and routine HCV screening using ALT and antibody testing should be considered for high-risk MSM with HIV, it recommends.

The study, "Sexual Transmission of Hepatitis C Virus Among HIV-Infected Men Who Have Sex with Men -- New York City, 2005-2010," was published in CDC's Morbidity and Mortality Weekly Report (2011;60(28):945-950).

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