Abstract
IntroductionHepatitis C virus (HCV) is a major public health threat. Although the recent availability of highly effective directly acting antivirals created optimism towards HCV elimination, there is ongoing transmission of HCV in men who have sex with men (MSM). We here report current epidemiological trends and synthesise evidence on behavioural, network, cellular and molecular host factors associated with sexual transmission of HCV, in particular the role of HIV‐1 co‐infection. We discuss prevention opportunities focusing on the potential of HCV treatment.MethodsWe searched MEDLINE, fact sheets from health professional bodies and conference abstracts using appropriate keywords to identify and select relevant reports.Results and discussionRecent studies strongly suggest that HCV is transmitted via sexual contact in HIV‐positive MSM and more recently in HIV‐negative MSM eligible for or on pre‐exposure prophylaxis. The reinfection risk following clearance is about 10 times the risk of primary infection. International connectedness of MSM transmission networks might contribute to ongoing reinfection. Some of these networks might overlap with networks of people who inject drugs. Although, the precise mechanisms facilitating sexual transmission remain unclear, damage to the mucosal barrier in the rectum could increase susceptibility. Mucosal dendritic cell subsets could increase HCV susceptibility by retaining HCV and transmitting the virus to other cells, allowing egress into blood and liver. Early identification of new HCV infections is important to prevent onward transmission, but early diagnosis of acute HCV infection and prompt treatment is hampered by the slow rate of HCV antibody seroconversion, which in rare cases may take more than a year. Novel tests such as testing for HCV core antigen might facilitate early diagnosis.ConclusionsHigh‐risk sexual behaviour, network characteristics, co‐infection with sexually transmitted infections like HIV‐1 and other concomitant bacterial and viral sexually transmitted infections are important factors that lead to HCV spread. Targeted and combined prevention efforts including effective behavioural interventions and scale‐up of HCV testing and treatment are required to halt HCV transmission in MSM.
Highlights
Hepatitis C virus (HCV) is a major public health threat
As new HCV infections were typically found in HIV-positive men who have sex with men (MSM), it was initially suggested that HIV-1 status could be an important factor for sexually acquired HCV [10,13,14,15]
Directly acting antiviral (DAA) treatment is very effective in clearing HCV [22], and its availability created optimism towards HCV elimination, the high HCVinfection rates, likely via sexual contact, highlight the need for a better understanding of the mechanisms involved in sexual transmission of HCV
Summary
Hepatitis C virus (HCV) is a major public health threat. the recent availability of highly effective directly acting antivirals created optimism towards HCV elimination, there is ongoing transmission of HCV in men who have sex with men (MSM). In contrast to hepatitis B, the risk of sexual transmission of HCV has always been considered low [3,4] This low risk was confirmed by a recent study among 500 anti-HCV-positive, HIV-negative persons and their long-term HCV-negative heterosexual partners, reporting a maximum incidence rate of HCV transmission by sex of 0.07% per year or one infection per 190,000 sexual contact, and a lack of association with specific sexual practices [5]. Directly acting antiviral (DAA) treatment is very effective in clearing HCV [22], and its availability created optimism towards HCV elimination, the high HCV (re)infection rates, likely via sexual contact, highlight the need for a better understanding of the mechanisms involved in sexual transmission of HCV
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