Incident Hepatitis C Virus Infection in Men Who Have Sex With Men: A Prospective Cohort Analysis, 1984-2011

Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA and Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA.
Clinical Infectious Diseases (Impact Factor: 8.89). 03/2013; 57(1). DOI: 10.1093/cid/cit197
Source: PubMed


Prospective characterization of hepatitis C virus (HCV) transmission in both human immunodeficiency virus (HIV)-infected and -uninfected men who have sex with men (MSM) over the entire HIV epidemic has not been comprehensively conducted.

To determine the trends in and risk factors associated with incident HCV in MSM since 1984, 5310 HCV antibody (anti-HCV)-negative MSM in the Multicenter AIDS Cohort Study were prospectively followed during 1984-2011 for anti-HCV seroconversion.

During 55 343 person-years (PYs) of follow-up, there were 115 incident HCV infections (incidence rate, 2.08/1000 PYs) scattered throughout the study period. In a multivariable analysis with time-varying covariates, older age (incidence rate ratio [IRR], 1.40/10 years, P < .001), enrollment in the later (2001-2003) recruitment period (IRR, 3.80, P = .001), HIV infection (IRR, 5.98, P < .001), drinking >13 alcoholic drinks per week (IRR, 1.68, P < .001), hepatitis B surface antigen positivity (IRR, 1.68, P < .001), syphilis (IRR, 2.95, P < .001), and unprotected receptive anal intercourse with >1 male partner (IRR, 3.37, P < .001) were independently associated with incident HCV. Among HIV-infected subjects, every 100 cell/mm(3) increase in CD4 count was associated with a 7% (P = .002) decrease in the HCV incidence rate up to a CD4 count of 500 cells/mm(3), whereas there was no association with highly active antiretroviral therapy.

The spread of HCV among both HIV-infected and -uninfected MSM in the United States has been ongoing since the beginning of the HIV epidemic. In HIV-infected men with <500 CD4(+) T cells, the HCV incidence rate was inversely proportional to CD4 T-cell count.

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    • "Currently, the epidemic appears to be levelling off in The Netherlands [23]. Outside Europe (the USA and Japan), this seems not to be the case, with recent reported incidence rates being between 0.21 per 100 PYFU and 2.49 per 100 PFYU [24] [25]. The acute HCV re-infection rate is even higher, with reported rates of 7.8 and 15.2 per 100 PYFU [26] [27]. "
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    Clinical Microbiology and Infection 04/2015; 21(8). DOI:10.1016/j.cmi.2015.03.026 · 5.77 Impact Factor
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    • "HIV-positive MSM appear to be at risk for sexual transmission of HCV.50–53 Although this is a population that is generally under regular medical care and for whom guidelines, including those related to HCV screening, are regularly updated, some studies have found that as many as 30% of HIV-infected patients were unaware of their status.54 "
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    ABSTRACT: Liver disease is currently one of the leading causes of hospitalization and death in HIV-positive individuals. Coinfection with the hepatitis C virus (HCV) is a major contributor to this trend. Besides hepatic damage, which is enhanced in the presence of HIV-associated immunosuppression, HCV may contribute to disease in coinfected individuals by potentiating immune activation and chronic inflammation, which ultimately account for an increased risk of cardiovascular events, kidney disease, and cancers in this population. Fortunately, hepatitis C therapeutics has entered a revolutionary era in which we hope that most patients treated with the new oral direct-acting antivirals (DAA) will be cured. However, many challenges preclude envisioning a prompt elimination of HCV from the coinfected population. Issues that should be addressed include the following: (1) rising incidence of acute hepatitis C in men who have sex with men, and expansion/recrudescence of injection drug use in some settings/regions; (2) adverse drug interactions between antiretrovirals and DAA; and (3) high cost of DAA, which may lead many to defer or fail to access appropriate therapy.
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