HCV is emerging as an STI among HIV-infected MSM: a threat to the MSM community?
Background: Although HCV is rarely transmitted sexually, since 2000 outbreaks of sexually transmitted HCV infections among HIV-infected MSM have been reported. We studied the HCV prevalence and determinants among MSM visiting a large STI clinic in the Netherlands (annual number of 24000 new consultations).
Methods: In May and November 2007, 2061 attendees of the STI clinic Amsterdam were interviewed about risk factors for blood-borne and sexually transmitted infections and anonymously screened for HIV and HCV antibodies. Additional HCV RNA tests were performed in all HIV-infected participants regardless of their HCV antibody status. Determinants of HCV infections were analysed using logistic regression. Phylogenetic analysis was used to determine evidence for sexual transmission.
Results: In total 448/2061 STI-clinic attendants were MSM. 2/358 (0.6%) of the HIV-negative MSM and 14/90 (15.5%) HIV-infected MSM were infected with HCV, 1/2 and 3/14 (21%) MSM respectively ever injected drugs (IDU). 3/14 HIV/HCV co-infected MSM tested HCV antibody negative but HCV RNA positive indicating possibly acute infection. In multivariate analysis HIV-infection (OR 14.31, 95%CI, 1.09-187.9), fisting (OR 57.4, 95%CI, 4.01-820.67) and IDU (OR 18.07, 95%CI, 1.05-309.9) were significantly associated with HCV. Fisting in itself was strongly correlated with the use of sex toys, group sex, bleeding during sex, and GHB use. Phylogenetic analyses including previously known MSM cases of acute HCV infection revealed a high degree of MSM-specific clustering.
Conclusions: We found a HCV prevalence of 15% in HIV-infected MSM attending the STI clinic, whereas before 2000 this was 1-4%. This increasing HCV prevalence and the possibly acute infections suggest a rapid spread of HCV. Independently of IDU, rough sexual techniques were associated with HCV. Phylogenetic analysis reveals the presence of MSM-specific HCV strains, also supporting sexual transmission. Targeted interventions including raising awareness are needed to stop the further spread among HIV-infected MSM, and a possible spill over to HIV-negative MSM.
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