Hepatitis C Virus Infections Among HIV-Infected Men Who Have Sex With Men: An Expanding Epidemic

Since 2000, outbreaks of sexually transmitted hepatitis C virus have been reported among HIV-positive men who have sex with men (MSM). In the current study, the authors conclude that the prevalence of HCV in this population is "high and increasing."

The setting for the research was a large STD clinic in Amsterdam, where the authors studied the prevalence and determinants of HCV among MSM.

In 2007 and 2008, an anonymous, bi-annual cross-sectional survey was administered to 3,125 patients, of whom 689 were MSM. Participants were interviewed and screened for HIV and HCV antibodies, and all anti-HCV-positive and HIV-positive persons were tested for HCV RNA. Phylogenetic analysis was used to compare HCV strains of the STD clinic patients with those isolated from MSM with acute HCV in 2000-2007. Logistic regression was used to analyze determinants of HCV infection.

HCV infection was diagnosed in two of 532 HIV-negative MSM (0.4 percent) and 28 of 157 HIV-positive MSM (17.8 percent). Among HIV-positive MSM, HCV prevalence increased from 14.6 percent to 20.9 percent during the study period. Acute HCV infection was noted among seven of 28 co-infected MSM (25 percent). Of the 28 co-infected men, only five reported any history of injection drug use (IDU).

HIV infection, IDU, fisting, and use of gamma hydroxyl butyrate (GHB) were found to be significantly associated with HCV infection. A high degree of MSM-specific clustering was found through phylogenetic testing.

"Though not statistically significant, this trend, and the relatively large population of acute infections suggest ongoing transmission of HCV in HIV-positive MSM," the authors concluded. "Regardless of IDU, rough sexual techniques and use of recreational drugs were associated with HCV infection; phylogenetic analysis supported sexual transmission. Targeted prevention, like raising awareness and routine testing, is needed to stop the further spread among HIV-infected MSM, and to prevent possible spillover to HIV-negative MSM."