Mnage  trois: increased prevalence of syphilis infection in HIV-positive MSM with acute hepatitis C.

Published: November 11, 2012

Abstract

In recent years, an increase in acute hepatitis C (HCV) infection has been observed in human immuno-deficiency virus (HIV)-positive men who have sex with men (MSM). Since sexual transmission of hepatitis C does not play as significant a role in other populations, there is much speculation surrounding its transmission in HIV-infected MSM. While injection-drug use appears to play only a minor role, other drug use and specific sexual practices are frequently reported. The purpose of this observational study was to investigate for a correlation with other sexually transmitted diseases (STDs). Data on 133 HIV-positive MSM with documented acute HCV infection were included in the analysis. We investigated for new or recurrent infections with Chlamydia trachomatis, Neisseria gonorrhea (direct detection of the pathogen) and Treponema pallidum (serological examination) within a time frame of 24 weeks prior to or after the acute HCV infection. The control group consisted of 1034 HIV-positive MSM without HCV infection with a follow-up of one year. HIV-infected MSM with acute HCV had a higher rate of syphilis infection when compared to HIV-positive HCV-negative controls (73% vs. 43%). 31% of patients in the HCV group acquired a new (seroconversion) or recurrent syphilis infection (significant titre increase using the Treponema pallidum particle agglutination test=TPPA) compared to 12% of controls (p<0.05). Further, 12 cases of Neisseria gonorrhea and 6 cases of Chlamydia trachomatis infection were observed in the HCV group. Due to the lack of routine screening for these infections in the control group, a comparison could not be made. Conclusions: We report a higher prevalence of other sexually transmitted diseases in HIV-infected MSM within 24 weeks before or after acute HCV infection. This observation however does not prove a pathophysiological connection between acute hepatitis C and other STDs. The high frequency of syphilis infections primarily affecting the ano-genital region suggests a possible correlation.

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