Abstract

BackgroundSexual transmission of Hepatitis C virus (HCV) in men who have sex with men (MSM) and its interaction with HIV status, sexually transmitted infections and sexual behaviour is poorly understood. We assessed the incidence and predictors of HCV infection in HIV positive MSM.MethodsThe electronic medical record and laboratory results from HIV positive MSM in care at a large urban public specialist HIV clinic embedded in a sexual health centre in Melbourne Australia were collected. Patients with two or more HCV antibody tests between January 2008 and March 2016 and with no record of injecting drug use were included. The HCV exposure intervals were the periods between a negative HCV test and the next HCV test. We compared HCV exposure intervals temporally associated with and without newly acquired syphilis or anorectal chlamydia. HCV exposure intervals were also categorised as being before or after HIV virological suppression and by most recent and nadir CD4 cell count.ResultsThirty seven new HCV infections were diagnosed in 822 HIV positive MSM with no history of injecting drug use over 3114 person years (PY) of follow-up. Mean age was 43.1 years (±12.5) and mean CD4 cell count nadir was 362 cells/uL (±186). The incidence of HCV infection in the study population was 1.19/100PY (0.99–1.38). The incidence in exposure periods temporally close to new syphilis infection was 4.72/100PY (3.35–6.08) and to new anorectal chlamydia infection was 1.37/100PY (0.81–1.93). The incidence in men without supressed viral load was 3.19/100PY (1.89–4.49). In the multivariate Cox regression analysis only younger age (aHR 0.67 (0.48–0.92)), exposure periods temporally associated to new syphilis infection (aHR 4.96 (2.46–9.99)) and higher CD4 cell count nadir (aHR 1.26 per 100 cells/uL (1.01–1.58)) were associated with increased risk of HCV infection. During the study period the incidence of syphilis increased dramatically but the incidence of HCV infection remained the same.ConclusionsIncidence of HCV infection is associated with syphilis but not anorectal chlamydia which suggests a biological rather than behavioural risk modification. Rising syphilis incidence may offset declines in HCV transmission through HCV treatment as prevention.

Highlights

  • Sexual transmission of Hepatitis C virus (HCV) in men who have sex with men (MSM) and its interaction with Human immunodeficiency virus (HIV) status, sexually transmitted infections and sexual behaviour is poorly understood

  • Eight hundred twenty-two MSM who attended for specialist care and were tested at least twice for HCV antibodies between January 1st 2008 and 31st March 2016 were included after excluding 172 women, 34 men with both injecting drug use (IDU) and MSM risk, 9 men with IDU risk only and 316 men with other modes of HIV transmission as their only recorded risk, and 95 men with no recorded risk factor

  • Thirty four of these were identified through HCV antibody testing, of whom 24 went on to have positive HCV Deoxyribonucleic acid (DNA) polymerase chain reaction (PCR)

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Summary

Introduction

Sexual transmission of Hepatitis C virus (HCV) in men who have sex with men (MSM) and its interaction with HIV status, sexually transmitted infections and sexual behaviour is poorly understood. A number of factors have been associated with sexual, and presumed permucosal, transmission in MSM but it is difficult to separate out the relative contribution of each risk factor due to their interrelationship. It is not clear how behavioural and biological factors influence transmission probability. Syphilis is associated with condomless receptive anal sex [13] Unlike anorectal chlamydia, it is associated with genital ulceration and is a marker of both behavioural and biological susceptibility. How host factors related to HIV infection, like immunosuppression, viremia, antiretroviral therapy (ART), virological suppression and immune recovery, affect risk of sexual acquisition of HCV has not been studied

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