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  XVII International AIDS Conference
Mexico City
3-8 August 2008
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HCV Emerging as New Sexually Transmitted Disease in MSM With HIV
  XVII International AIDS Conference
August 3-8, 2008
Mexico City
Mark Mascolini
Prevalence of hepatitis C virus (HCV) infection quadrupled among HIV-infected men who have sex with men (MSM) in Amsterdam over the past 8 years [1]. Independently of injecting drug use, rough sex hoisted the HCV risk 15 times in men with HIV.
Twice in 2007 and once in 2008, Dutch researchers interviewed 3124 people attending a busy sexually transmitted disease clinic in Amsterdam and tested them for HIV and HCV. Everyone got an HCV antibody test, and anyone with HIV had an HCV RNA test.
Among 2435 heterosexual men and women interviewed and tested, only 7 (0.3%) had HCV infection. Among 689 MSM, 532 did not have HIV, and only 2 of those 532 (0.4%) had HCV. In stark contrast, 28 of 157 HIV-infected men (17.8%) also had HCV. Of these 28 coinfected men, only 5 (17.9%) ever injected drugs. HIV/HCV coinfection prevalence rose gradually over the three study months:
- May 2007: 14.6% (7 of 48) coinfected
- November 2007: 16.7% (7 of 42) coinfected
- April 2008: 20.9% (14 of 67) coinfected
Nine of the 28 coinfected men (32%) had a negative HCV antibody test but a positive HCV RNA test, a discordance suggesting acute HCV infection. Nine of these 28 did not know they had HCV before testing.
Statistical analysis considering multiple HCV risk factors underlined three independent predictors of HCV:
- HIV infection raised the risk of HCV almost 40 times (odds ratio [OR] 38.4, 95% confidence interval [CI] 4.6 to 323.0, P < 0.001).
- Injecting drug use made HCV 15 times more likely (OR 15.5, 95% CI 2.4 to 100.9, P = 0.004).
- Fisting (penetrating a partner's rectum with the fist) also raised the HCV risk 15 times (OR 15.0, 95% CI 4.6 to 48.9, P < 0.001).
The yawning confidence intervals for these odds ratios probably reflect the small number of men with HCV. Nonetheless, Urbanus and coworkers maintained, the fisting link with HCV supports the likelihood of sexual transmission. The investigators backed that hypothesis with phylogenetic analyses confirming related HCV species in the infected men. Fisting strongly correlated with sex toy use, group sex, bleeding during sex, and use of gamma hydroxybutyrate (GHB), a party drug that can have both euphoric and sedative effects.
Urbanus and colleagues noted that the overall 17.8% prevalence of HCV in HIV-infected MSM in this 2007-2008 study contrasts with rates of 1% to 4% recorded before 2000 in gays with HIV. They proposed that "this increasing HCV prevalence and the possibly acute infections suggest a rapid spread of HCV" among Dutch MSM. HCV infection not only threatens HIV-infected gays, they cautioned, but could spread further among HIV-negative MSM.
Recent research in Amsterdam [2], Boston [3], and London and Brighton [4] found evidence of climbing HCV rates in gay men with or without HIV who did not inject drugs. But studies in Madrid [5] and Seattle, San Diego, and New York City [6] did not. (from Jules: researchers at Mt Sinai Hospital in NYC have reported MSM who had HIV and then contracted HCV, and that these patients experienced accelerated HCV disease progression, suggesting immunosuppression at the time of contracting HCV may accelerate HCV disease progression).

1. Urbanus AT, van de Laar TJW, Schinkel J, et al. HCV is emerging as an STI among HIV-infected MSM: a threat to the MSM community? XVII International AIDS Conference. August 3-8, 2008. Mexico City. Abstract THPDC203.
2. van de Laar TJ, van der Bij AK, et al. Increase in HCV incidence among men who have sex with men in Amsterdam most likely caused by sexual transmission. J Infect Dis. 2007;196:230-238.
3. Cohen DE, Russell CJ, Golub SA, Mayer KH. Prevalence of hepatitis C virus infection among men who have sex with men at a Boston community health center and its association with markers of high-risk behavior. AIDS Patient Care STDS. 2006;20:557-564.
4. Giraudon I, Ruf M, Maguire H, et al. Increase in diagnosed newly acquired hepatitis C in HIV-positive men who have sex with men across London and Brighton, 2002-2006: is this an outbreak? Sex Transm Infect. 2008;84:111-115. 5. Ruiz-Sancho A, Barreiro P, Castellares C, et al. Outbreak of syphilis, but not of acute hepatitis C, among HIV-infected homosexual men in Madrid. HIV Clin Trials. 2007;8:98-101.
6. Buffington J, Murray PJ, Schlanger K, et al. Low prevalence of hepatitis C virus antibody in men who have sex with men who do not inject drugs. Public Health Rep. 2007;122(suppl 2):63-67.