Hepatitis C is a virus that attacks the liver. In Canada, hepatitis C is most commonly transmitted through the sharing of injection drug use equipment. However, there has been a recent increase in the sexual transmission of hepatitis C among gay, bi and other men who have sex with men (MSM) in high-income countries, particularly among HIV-positive men.1,2
This article summarizes the results from a systematic review and meta-analysis3 which aimed to estimate how high the prevalence (the total number of people who are living with a condition at a point in time in a defined population) of chronic hepatitis C is among MSM.
In total, 42 studies were included in the final analysis to estimate the prevalence of hepatitis C among HIV-positive MSM. All studies were from middle- or high-income countries, including two from Canada.4,5 In total, 38,986 HIV-positive MSM were included in these studies.
When all prevalence estimates were combined from the 42 articles, the hepatitis C antibody prevalence (the estimated rate of any HIV-positive MSM who have or ever had hepatitis C) was 8.2% overall. This means that an estimated 8.2% had evidence of a current or past hepatitis C infection. The hepatitis C antibody-positive prevalence was estimated to be:
Estimates of chronic hepatitis C infection were lower because they removed the people who had cleared the virus on their own. Overall, the prevalence of chronic hepatitis C among all HIV-positive MSM ranged from 5.3% to 7.3%. The estimated range of chronic hepatitis C infections was higher among MSM who had ever used injection drugs compared to those who had never used:
The estimated prevalence of chronic hepatitis C increased from 2.9% in 1988 to 15.7% in 2011. This increase was statistically significant. When the numbers are broken down, a statistically significant year on year increase in hepatitis C prevalence was found among HIV-positive MSM who had never used injection drugs (0.37%/year). However, there was a statistically significant year on year decrease in hepatitis C prevalence among HIV-positive MSM who had ever used injection drugs (minus 1.4%/year).
These numbers suggest that increases in new hepatitis C infections among HIV-positive MSM may increasingly be related to sexual transmission rather than injection drug use.
This systematic review found that between 1988 and 2011, the estimated prevalence of hepatitis C among HIV-positive gay men increased significantly and that this cannot be solely related to use of injection drug. The rates remain low, however, which gives us an opportunity to reduce the impact of hepatitis C among HIV-positive MSM.
To support HIV-positive MSM to reduce their risk of acquiring or transmitting hepatitis C, service providers can counsel all MSM on the following:
Systematic reviews are important tools for informing evidence-based programming. A systematic review is a critical summary of the available evidence on a specific topic. It uses a rigorous process to identify all the studies related to a specific research question. Relevant studies can then be assessed for quality and their results summarized to identify and present key findings and limitations. If studies within a systematic review contain numerical data, this data can be combined in strategic ways to calculate pooled estimates. Combining data to produce pooled estimates can provide a better overall picture of the topic being studied.
Logan Broeckaert holds a Master's degree in History and is currently a researcher/writer at CATIE. Before joining CATIE, Logan worked on provincial and national research and knowledge exchange projects for the Canadian AIDS Society and the Ontario Public Health Association.
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