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Acute HCV in MSM in London
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Published on behalf of the British HIV Association and the European AIDS Clinical Society (May 2007) , 13th Conference Edinburgh, april 2007
The continued increase in acute hepatitis C in men who
have sex with men is not only confined to those infected
with HIV
N Brejt, L Mckie, P Mayhead, M Fisher, C Sabin, J Tibble and D Richardson
1Royal Sussex County Hospital, Brighton, UK, 2Department of Primary Care and
Population Sciences, Royal Free and University College Hospital Medical
School, London, UK
ABSTRACT
Background: Transmission of hepatitis C virus (HCV) amongst cohorts of HIV-infected men who have sex with men (MSM) has been increasingly reported,
possibly resulting from high-risk sexual behaviour. As HIV-negative MSM do
not routinely undergo 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 centre between 2000
and 2006. Subjects were included if they had at least two HCV-ab tests during the study period, of which the first was negative. Subjects were classified as HIV-positive, negative, or untested based upon the proximal HIV-ab result to the HCVab test. Information on sexual behaviour was also collected.
Results: A total of 7169 MSM were seen, of whom 1570 had at least two HCV-ab
tests. 25 individuals were diagnosed with acute HCV. The seroconversion rates in: HIV-negative group was 0.316/100 person years (pyrs) [95% CI 0.103-0.737],
HIV-positive group 1.944/100 pyrs [1.111-3.157], HIV unknown was 0.415/100
pyrs [0.113-1.063]. There has been an increased seroconversion rate over time.
The rates in 2003, 2004, 2005 and 2006 were 0.13 [0.016-0.470], 0.162 [0.044-
0.414], 0.193 [0.071-0.420], 0.369 [0.196-0.630] respectively.
Overall, the seroconversion rate increased by 59% per year (RR per year 1.59 [1.13-2.25], P = 0.008). The rate of unsafe sexual behaviour is greater in this group of MSM.
Conclusions: There has been, and continues to be a significant increase in acute HCV in MSM. Contrary to available evidence, this phenomenon is not exclusive to those men with HIV. This would suggest that routine HCV testing is required in all MSM presenting to STD/HIV services.
Acute hepatitis C in HIV-infected men who have sex with
men: the epidemic continues
Alison Rodger, THN Wong, Tom Fernandez, Margaret Johnson, Gabrielle Slapak and Sanjay Bhagani
Royal Free Hospital, London, UK
ABSTRACT
Aim/objective: We have previously reported sexual transmission of hepatitis C virus (HCV) among HIV-positive men who have sex with men (MSM). This study
reports a single-centre experience of ongoing HCV transmission.
Methods: This is a descriptive study of 58 HIV-infected men who acquired HCV infection within the past 5 years. New HCV infection is defined as documented seroconversion to anti-HCV and RNA positivity following a previous negative result. Sociodemographic and behavioural data were also collected on these
men.
Results: The incidence rate of new HCV infection per 1000 patients attending was in one in 2001, six in 2002, six in 2003, seven in 2004, six in 2005 and four in 2006. Mean age was 37 (SD ± 6.57) years.
All reported unprotected anal intercourse and in 64% this was the only risk factor.
Fisting was reported in 21% and 16% had a diagnosis of syphilis in the preceding 6 months. Only 14% reported injecting drug use.
The main reason for testing for HCV was abnormal liver function tests (LFTs) (n = 33, 57%) seen in 95% (n = 55). Only one was symptomatic however. Median ALT was 233 (IQ range 85-453). Median length of HCV infection at diagnosis
(from previous negative test) was 134 days (IQ range 88-278). Genotype 1 predominated (n = 38, 69%). Median HCV viral load at diagnosis was 1.4 million IU/l (IQ range 0.12-2.4).
Conclusions: Our experience suggests ongoing HCV transmission in HIV-positive
men. All MSM should have an annual HCV screen. Patients with unexplained abnormal liver enzymes and risky sexual practices (particularly those which damage mucosal surfaces such as fisting) should be screened more frequently. The public health messages relating to the risk of HCV transmission in this group need to be robust and effective.
Delayed antibody seroconversion in HIV-positive men
superinfected with hepatitis C virus
Emma Thomson1, Eleni Nastouli2, Janice Main1, Peter Karayiannis1, David Muir1 and Myra McClure2
1Imperial College, London, UK, 2St Mary's Hospital, London, UK
ABSTRACT
Aim/objective: An epidemic of acute hepatitis C infection amongst HIVpositive
men has been reported in London and other European cities. Early diagnosis and treatment results in improved sustained virological response (SVR) rates following treatment with pegylated interferon and ribavirin (59% versus 40%). Antibody testing for hepatitis C infection is used as the main screening method in many hospitals although there have been reports of delayed seroconversion in HIV-positive patients. We assessed the sensitivity of antibody versus RT-PCR at 3-monthly intervals.
Methods: Stored plasma samples from 30 patients diagnosed with acute
hepatitis C infection were analysed by qualitative RT-PCR and antibody testing
(Monolisa, BioRad).
Results: 30 men who have sex with men (MSM) with acute hepatitis C infection were identified (53.3% genotype 1a, 26.7% genotype 4d, 3.3% genotype 1b, 3.3% genotype 3a, 13.4% untyped). Mean CD4 cell count was 612 x 106/l (range 290-1370 x 106/l). At baseline with a positive PCR test, 77% of patients had a negative antibody test (sensitivity = 23%). 3 months later, 35% of patients still had a negative antibody test (sensitivity 65%). Mean ALT at baseline was 208. Two patients were excluded because they had persistently positive PCR tests despite negative antibodies.
Conclusion/discussion: Reduced sustained viral load response rates in HIV-positive patients may in part be due to delayed antibody seroconversion and could result in delayed treatment. Where there is high clinical suspicion of
recent hepatitis C infection e.g. raised ALT levels, HIV-infected patients should be screened for the presence of HCV RNA (there have been numerous published studies in journals that antibody negative patients with IDU background should use HCV viral load test for diagnosis). HIV-infected patients diagnosed with acute hepatitis C should have a preceding negative HCV RNA test to establish the diagnosis.
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