Half of HIV-negative men who have sex with men (MSM) with acute hepatitis C (HCV) infection at a London sexual health clinic used recreational drugs, according to results of a 2010-to-2014 retrospective study. In a typical month, only 15% of HIV-negative gay/bisexual men attending the clinic got screened for HCV infection.
Research documents epidemic type of rates of acute HCV infection in some European and U.S. populations of HIV-positive MSM, including many MSM who do not inject drugs. These findings establish the risk of sexual HCV transmission, but scant work has focused on acute HCV rates in sexually active HIV-negative MSM.
This retrospective analysis involved HIV-negative MSM seen at a sexual health clinic in London, England, from January 2010 to May 2014. Using European AIDS Network criteria, researchers identified 44 men with acute HCV infection.
The study group had a median age of 37 years (24-75), and 35 men (79.5%) were white. Forty-one men (93%) reported anal sex without a condom, including 36 (82%) who had both receptive and insertive anal intercourse. The 44 men had an average 7.3 sex partners (1-100), 12 (27%) had group sex and 11 (25%) practiced fisting. Half of the men reported recreational drug use -- including cocaine, ketamine and crystal meth -- and 14 men (32%) had condomless sex while using recreational drugs. Only nine men (20%) said they injected drugs.
Twenty-nine of the men (66%) knew their partner's HCV or HIV status. Two men had sex with a partner they knew had HCV, 13 with a partner they knew had HIV and six with a partner they knew had both HCV and HIV. Thirteen men (29.5%) had another sexually transmitted infection when diagnosed with HCV. Eight (18%) had taken post-exposure prophylaxis (PEP) to ward off possible HIV infection in the six months before acute HCV diagnosis.
The researchers picked a typical month, November 2013, in which 3,811 HIV-negative MSM visited the sexual health clinic. Only 565 of these men (15%) got screened for HCV infection.
"HCV testing should be part of routine sexual health screening [in HIV-negative men] with risk factors, particularly in environments with high HCV prevalence," the researchers note. They underline the need for accurate history taking, documentation of drug use and implementation of risk prevention strategies in such men.
Mark Mascolini is a freelance writer focused on HIV infection.