HCV Testing in HIV-Infected MSM: Once Is Not Enough
A high incidence of HCV seroconversion in this population implies that repeat HCV testing should be routinely performed, particularly in individuals with high-risk sexual behaviors.
Although hepatitis C virus (HCV) infection has been linked predominantly to injection-drug use (IDU), there is a growing recognition that HCV is also transmitted sexually among HIV-infected men who have sex with men (MSM) (JW AIDS Clin Care Aug 8 2011). To understand the magnitude of this problem, researchers evaluated HCV prevalence, incidence, and risk factors in HIV-infected MSM receiving care at a health center in Boston.
Among 1059 HIV-infected MSM who were seen at least twice at the health center between January 2008 and June 2009 and underwent at least one HCV antibody test, 6% had a positive result at initial screening or were HCV seropositive before entering care (i.e., had prevalent HCV infection). Of the 995 MSM who were initially HCV antibody negative, 379 (38%) underwent one or more repeat HCV tests; of those, 23 (6%) seroconverted during 1408 person-years of follow-up, for an HCV incidence of 1.63 cases per 100 person-years.
In terms of risk factors, only one third of HIV-infected men with prevalent or incident HCV infection reported a history of IDU, implying that many of the others acquired HCV sexually. This supposition is supported by the fact that 87% of patients with incident HCV infection — and 64% of those with prevalent infection — had a history of other sexually transmitted infections. Compared with HIV-infected MSM who had prevalent HCV infection, those with incident infection were younger (median age, 37 vs. 44). Among 22 patients who initiated HCV therapy, the rate of sustained virologic response was 59% overall and higher in individuals with incident than in those with prevalent HCV infection (86% vs. 47%).
CITATION(S):
Garg S et al. Prevalent and incident hepatitis C virus infection among HIV-infected men who have sex with men engaged in primary care in a Boston community health center. Clin Infect Dis 2013 Mar 26; [e-pub ahead of print].
