Sexual transmission of HCV in Brighton reported in HIV positive and HIV negative MSM
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.
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.
The oral presentation can be viewed online from the CROI website (see Wednesday, 10.00-11.45am Hepatitis B and C).