London study finds sexual and intranasal transmission of HCV

A cohort study of 23 HIV-positive gay men attending a London clinic with acute hepatitis C infection has found clinical and molecular evidence to suggest both sexual and intranasal transmission of HCV. Mark Danta and colleagues from the Royal Free Hospital also conclude that a higher CD4 count appears to predict spontaneous HCV eradication.

In a paper presented to the 54th Annual Meeting of the American Association for the Study of Liver Diseases in Boston, Massachusetts in October, the authors report that unprotected sexual intercourse was a universal risk factor in the cohort, 16 subjects (70%) reported group sex and fisting, 15 (65%) reported intranasal drug use, and four (17%) reported injected drug use.

The hypothesis of sexual transmission was supported by the fact that 10 (43%) had a documented STD (seven syphilis and one gonorrhoea) including two patients with acute HIV seroconversion. At the time of the report, five isolates had been sequenced and three appeared related by phylogenetic analysis, suggesting a common source.

Four patients eradicated HCV spontaneously, and they had significantly higher CD4 counts (810 versus 556, p<0.05) but there was no correlation with peak ALT or HIV viral load. Nine patients were treated with pegylated interferon and ribavirin.

In the last issue of HTB (Vol 4, No 10), we reported a different paper describing this cohort, and another study at the Chelsea and Westminster Hospital, both of which indicated an epidemic of acute HCV in London, transmitted sexually among HIV-positive men who have high-risk, unprotected sex with other men.

Comment

Aggressive sex practices seem to be the key risk factor for transmitting HCV which is efficiently transmitted by blood. This explains too the intranasal transmission mainly associated with cocaine use.

Danta M, Brown D, Jacobs M et al. Epidemiology of acute HCV infection in a London cohort of HIV positive homosexual males. 54th Annual Meeting of the American Association for the Study of Liver Diseases, Boston, Massachusetts, 24-28 October 2003. Abstract 561.