Simon Collins, HIV i-Base

Daniel Richardson presented updated results from the HCV screening programme run in Brighton. Although HCV screening is recommended in HIV-positive men on HIV diagnosis and prior to starting HIV treatment, UK guidelines do not routinely recommended HCV screening for HIV-negative men. Because Brighton has a high prevalence of HIV in MSM (approximately 13%, 30% of which are undiagnosed), and had reported sexual transmission of HCV in HIV-positive men, in 2000 they expanded their HCV screening programme to include all MSM.

GUM and HIV services in Brighton are provided in a single site. Of 7169 registered patients, 3907 eligible men (with 1 or more HCV negative result) and were followed for over 11,000 patient years of follow-up. Men who reported a history of injection drug use were excluded from the analysis. From 2000-2006, the programme identified 25 incident cases of HCV (2, 4, 6 and 13 each year from 2003-2006) and 121 incident cases of HIV. 16/25 cases were in HIV-positive patients and 9/25 were HIV-negative or unknown HIV status. However, over follow-up 8/9 people later became HIV-positive (the remaining patient was lost to follow-up). HCV incidence rates per 1000 patient years over this period increased by 60% a year: 0 in 2002, 1.4 in 2003, 1.6 in 2004, 1.9 in 2005 and 3.6 in 2006 (RR 1.59 per year, 1.13 to 2.25, p = 0.008).

HIV-status was a major risk factor (adj. RR 13.59 compared to HIV-negative status (4.98 to 37.09, p=0.0001), although nearly all infections were in patients with >400 CD4 counts, and a significant proportion had normal LFTs. Other risk factors that were indentified included unprotected anal intercourse in 20/25 cases (both as an active and passive partner), two or more sexual partners in the previous three months in 21/25 patients, and having one of more sexually transmitted infections in the previous six months in 15/25 cases.

In discussing the increasing number of HCV infections among HIV-positive MSM, it is not clear whether HIV-serosorting is mainly restricting new HCV infection to HIV-positive men, or whether HIV is a factor in driving increased risk (for example through higher HCV levels in semen of coinfected men). Although the recent increase in number of cases in HIV-negative men has relatively low numbers, this led the researchers to recommend their policy for including screening for HCV as a sexually transmitted infection in MSM in Brighton irrespective of HIV status. The almost exclusive progression to HIV infection in the HIV-negative men diagnosed with sexually transmitted HCV (8/9 men) is alarming.

Ref:
Richardon D, Fisher M, Sabin C. Acute hepatitis C in men who have sex with men is not confined to those infected with HIV, and their number continues to increase. Oral abstract 130.
http://www.retroconference.org/2007/Abstracts/29976.htm
The oral presentation can be viewed online from the CROI website (see Wednesday, 10.00-11.45am Hepatitis B and C).