Abstract
During the last decade, outbreaks of acute hepatitis C virus (HCV) infection have been reported among human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) in several European countries. To study this emerging infection in MSM in Antwerp, Belgium, we reviewed all cases of newly acquired HCV infection in HIV-positive MSM followed from 2001 to 2009 at the HIV/sexually transmitted infection (STI)reference clinic of the Institute of Tropical Medicine in Antwerp. Newly acquired HCV infection was considered as certain or probable according to local definitions. During the study period, 69 episodes of newly acquired HCV infection (40 certain and 29 probable) were diagnosed in 67 HIV-infected MSM. In only 10 episodes (14%) were the patients symptomatic. The annual incidence of HCV infection in our population of HIV-infected MSM rose steadily from 0.2% in 2001 to 1.51% in 2008, and then peaked to 2.9% in 2009. For 60 episodes (87%), another STI (mainly syphilis and lymphogranuloma venereum) had been diagnosed within the six months before the diagnosis of HCV infection. All but one patient with available genotyping (n=54) were found to be infected with the difficult to-treat HCV genotypes 1 or 4. Our results therefore demonstrate the rising incidence of HCV infection in HIV-positive MSM in Antwerp, since 2001, which reached an alarming level in 2009. Targeted awareness campaigns and routine screening are urgently needed to limit further HCV spread and its expected long-term consequences.
Highlights
Since 2000, the prevalence and incidence of hepatitis C virus (HCV) infections have increased in human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) in large cities in the Netherlands [1], United Kingdom [2], France [3], the United States [4] and Australia [5]
High prevalence of ulcerative sexually transmitted infections (STIs), mainly syphilis and lymphogranuloma venereum (LGV), has been reported in HIV/HCV co-infected MSM [9,10] suggesting that HCV infections among MSM epidemiologically follow the epidemics of syphilis, and of LGV [14,15,16]
Phylogenetic analyses have revealed a high degree of HCV clustering among HIV/HCV co-infected MSM in Amsterdam, the Netherlands [1,7] and the existence of a large, international network of HCV transmission in HIV-positive MSM has been demonstrated in several European countries [18]
Summary
Since 2000, the prevalence and incidence of hepatitis C virus (HCV) infections have increased in human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) in large cities in the Netherlands [1], United Kingdom [2], France [3], the United States [4] and Australia [5]. Sexual transmission of HCV is known to be rather inefficient in discordant heterosexual couples, recent observations suggest that this is the most likely mode of HCV acquisition among HIV-infected MSM [1,6,7,8]. High prevalence of ulcerative sexually transmitted infections (STIs), mainly syphilis and lymphogranuloma venereum (LGV), has been reported in HIV/HCV co-infected MSM [9,10] suggesting that HCV infections among MSM epidemiologically follow the epidemics of syphilis (observed since the beginning of 2000 [11,12,13]), and of LGV (which emerged a few years later) [14,15,16]. A second objective was to document the current management and clinical outcome of these co-infected patients
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