September 11, 2014
HIV-negative men who have sex with men (MSM) appear to be contracting acute hepatitis C (HCV) through sexual practices, rather than via parenteral transmission, according to a study presented by Katie McFaul, M.D., at ICAAC 2014 in Washington, D.C.
The study identified 44 cases of acute HCV infection in HIV-negative MSM over a four-year period, which McFaul acknowledged may not sound like a high prevalence, but the hospital wasn't looking for HCV in this population.
"If you don't take the temperature, you won't find the fever," McFaul said. "HIV-negative MSM remain at risk of hepatitis C infection because we know that they share similar risk behaviors as HIV-positive MSM."
On the other hand, there may not be a high burden of HCV among HIV-negative MSM in every setting -- or at least not yet, according to another study among HIV-negative MSM from the Lemanic region of Switzerland presented by Matthias Cavassini, M.D., of the University of Lausanne. This study performed rapid screenings of 654 consenting MSM and only found one case of HCV (a prevalence of 0.15%) in an HIV-negative man. However, a survey conducted in the same men found that more than half lacked basic knowledge of HCV -- and sexual practices that could put MSM at risk were commonplace in the cohort -- leading Cavassini to ask, "Is this an accident waiting to happen?"
Most HCV infections are acquired after blood-to-blood contact via parenteral transmission -- either blood transfusions (before screening began), tattooing and body piercing, occupational exposure, medical procedures, and intravenous drug use. As increasing numbers of MSM have been injecting drugs recreationally -- engaging in "slamming" or "chem sex" -- the prevalence of HCV is increasing.
However, sexual transmission of HCV has also been reported among HIV-positive MSM who engage in specific sexual practices, particularly in the past few years. Factors relevant to transmission in this group include traumatic sexual practices (such as fisting and sharing sex toys), sexually transmitted diseases (such as chlamydia and gonorrhea) and increasing numbers of sexual partners including those who engage in drug use.
Given the high and increasing prevalence, screening for HCV in HIV-positive MSM is widely recommended. But as both Cavassini and McFaul pointed out, this is not being done in HIV-negative men and thus HCV prevalence among the HIV-negative MSM population is unknown. However, they are engaging in the same high-risk behaviors as HIV-positive men.
In the Swiss study, the participants reported a median of five sexual partners (range 0-400); 52% had been screened for STDs and 11% had an STD diagnosis in the last year.
Of the high-risk factors for HCV:
The sole participant who was identified with HCV reported no high-risk factors for HCV other than unprotected anal intercourse with two partners in the previous year.
Notably, individuals known to be HCV positive were excluded so the prevalence of HCV may be underestimated. However, given that injecting drug use is not very common in this community, it is possible fewer sex partners had the virus, and thus, there is very little transmission at this time. But Cavassini stressed, the combination of low awareness and high-risk behavior could be quite dangerous.
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