Hepatitis C Virus Seroprevalence, Incidence, and Screening Patterns in Ontario Pre-exposure Prophylaxis Users

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Abstract Background Hepatitis C virus (HCV) has emerged as a sexually transmitted infection in gay, bisexual, and other men who have sex with men (GBM). We estimated the seroprevalence and incidence of HCV infection and examined patterns of HCV testing among GBM using HIV pre-exposure prophylaxis (PrEP) in Ontario, Canada. Methods We analyzed data from the Ontario PrEP Cohort Study (ON-PrEP), a prospective cohort of PrEP users from 10 Ontario clinics. Participants completed an online questionnaire and study staff collected clinical information into a study database biannually for two years. We estimated the baseline seroprevalence and incidence of HCV infection and examined patterns of HCV testing during follow-up. We further explored differences in sociodemographic/clinical variables between those with and without prevalent/incident HCV infection through bivariate analysis. Results Among 557 eligible PrEP users, 382 (68.6%) underwent baseline HCV antibody testing, of whom five tested HCV-seropositive, giving a seroprevalence of 1.3% (95% CI=0.43-3.03). Only 245 (43.9%) participants underwent HCV antibody testing after baseline, and median time to participants’ first follow-up test was 245 days. During follow-up, two participants tested newly HCV-seropositive, giving an incidence of 0.47/100 PY (95% CI=0.06-1.69) over 428.9 years of follow-up. Participants with prevalent/incident HCV infection during the study appeared more likely to report giving money, drugs, gifts, or services for sex in the three months preceding enrolment compared to those who never tested HCV-seropositive (P=0.02). Conclusion HCV seroprevalence and incidence were low but not negligible among Ontario PrEP users. HCV antibody and RNA testing were suboptimal.