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Acute Hepatitis C in Men Who Have Sex With Men Is Not Confined to Those Infected with HIV, and Their Number Continues to Increase
Martin Fisher*1, D Richardson1, and C Sabin2
1Royal Sussex County Hosp, Brighton, UK and 2Royal Free and Univ Coll London Med Sch, UK
Background: Transmission of hepatitis
C (HCV) among cohorts of HIV-infected men who have sex with men (MSM) have been
increasingly reported over the past few years, possibly resulting from
high-risk sexual practices. Since acute HCV is usually asymptomatic, diagnoses
are generally made by routine HCV antibody (HCV-ab) screening or by
investigating significant transaminase rises. Since HIV– MSM do not
routinely undergo HCV-ab screening, it is unclear whether there has been a
similar increase in acute HCV in this group.
Methods: Subjects were MSM
attending a single HIV/STD center between 2000 and 2006. Subjects were included
if they had had at least 2 HCV-ab tests during the study period, of which the
first was negative. If any subsequent test was HCV+, the time of
acquisition was attributed as the time of the positive test. Subjects were
classified as HIV+, HIV–, or untested.
Results: During the study
period, 7223 MSM were seen, of whom 34 individuals were diagnosed with acute
HCV; 10 were HIV+, 6 HIV–, and 10 HIV-untested. The
seroconversion rates in the HIV– group was 41.6/100 person-years (95%CI
15.3 to 90.5); HIV+ group 53.0/100 person-years (25.4 to 97.5); HIV
unknown 38.2/100 person-years (18.3 to 70.3). Although the rate was
higher in the HIV+ group, this is not statistically significant
(relative rate RR 1.27, 0.46 to 3.51, p
= 0.64). There is an increased seroconversion rate over time. The rates in
2001, 2002, 2003, 2004, and 2005 were 11.0 (0.3 to 61.4), 20.3 (4.2 to 59.4),
53.3 (24.4 to 101.3), 63.8 (29.2 to 121.2), and 86.4 (23.6 to 221.3),
respectively. The relative rates (and 95%CI) for 2001, 2002, 2003, and 2004
(compared with 2005) were 0.13 (0.01 to 1.14), 0.24 (0.05 to 1.05), 0.62 (0.19
to 2.00), and 0.74 (0.23 to 2.40). Overall, the seroconversion rate
increased by 59% per year (RR per year 1.59, 1.13 to 2.25, p = 0.008).
Conclusions: There has been, and
continues to be a significant increase in acute HCV in MSM. Contrary to current
evidence, this phenomenon is not exclusively in MSM with HIV. This would
suggest that routine HCV testing is required in all MSM presenting to sexually
transmitted disease (STD)/HIV centers.
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