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"Acute HCV infection of HIV-infected MSM in New York City is sexually transmitted"......"HCV epidemic in both HIV-infected and -uninfected MSM has been ongoing for decades"
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"New York State Department of Health AIDS Institute recommends annual HCV antibody testing for HIV-infected patients who have continued high-risk drug and/or sexual behaviors but are seronegative for HCV"
Reported by Jules Levin, NATAP
Acute HCV in HIV+ MSM in NYC & Reinfection - here is a history of study research presented over the past 7+ years about acute HCV in HIV+ MSM in NYC, by Daniel Fierer MD at Mt sinai and the group at Cornel including Leah Burke MD & Kristen Marks MD; and on the study immediately below reported at AASLD in 2013 they reported 7 reinfections out of only 75 treated, that is 10% reinfection rate. Dr Fierer has been studying & following this patient group in NYC for many years and has collected quite a lot o data, the only group(s) in NYC I know of to study this group. The studies in NYC by Fierer & from Western Europe & London go back to 2007 & you can see the MACS study in the USA below where they report: "HCV epidemic in both HIV-infected and -uninfected MSM has been ongoing for decades". Of note
US ACTG ALLRT Study - HCV Sexual Transmission among MSM HIV+ in the USA: "sexual transmission is likely to be responsible for incident HCV infection" in men.......http://www.natap.org/2011/HCV/020511_06.htm......."sexual transmission is likely to be responsible for incident HCV infection" in men in this ACTG ALLRT study analysis of 2,800 men....."at-risk HIV-infected persons should have access to ongoing HCV surveillance.....A total of 1830 men had an initial negative HCV antibody test result and at least 1 subsequent HCV antibody test result, contributing >7000 person-years. At the time of the initial negative HCV antibody test result, 94% of men were receiving highly active antiretroviral therapy (HAART) and 6% reported current or prior IDU. Thirty-six seroconverted
Acute HBV & HCV Infection Among MSM: CDC Data from Population-Based Surveillance, 2006-2008......http://www.natap.org/2009/ICCAC/ICCAC_75.htm........This CDC reports only 14 adult MSM who are infected with acute HCV. Of these 14 6/12 report injection drug use, 9/12 report multiple sex partners, 0/6 report sexual contact with a confirmed or suspected case of HCV, and 12/14 report 1 or more drug or sexual risk factors listed above. As you may know European researchers from major cities in Western Europe including London and Paris have reported numerous cases at conferences of acute HCV among MSM with HIV due to unsafe sexual behavior and not IV drug use. Here in the USA the only recent research into this phenomenon has come out of NYC's Mt Sinai Hospital and Daniel Fierer, MD who has conducted research and reports finding a similar phenomenon and in addition reports accelerated HCV progression among already HIV-infected individuals who then experience acute HCV-infection, and these individuals are reportedly infected through unsafe sex.
(MACS Study) Incident Hepatitis C Virus Infection in Men Who Have Sex With Men: A Prospective Cohort Analysis, 1984-2011 'HIV-infection (6-fold), unprotected receptive anal intercourse (3-fold) increase risk for HCV acquisition, low CD4, syphils' - (09/20/13)......"this study demonstrates that the HCV epidemic in both HIV-infected and -uninfected MSM has been ongoing for decades. We also demonstrate that HIV infection, especially among men with lower CD4 T-cell counts; older age; and being the receptive partner with multiple unprotected sex partners increase the risk for HCV infection in MSM." .......the rates in the HIV-infected MSMs are significantly higher. Furthermore, among HIV-infected MSM, this is the first study to report a significantly higher HCV IR in men with lower CD4 T-cell counts......This study identified URAI (unprotected receptive anal intercourse) with multiple partners as the sexual behavior carrying the greatest risk for of HCV transmission......HIV infection led to a 6- to 8-fold higher incidence of HCV after adjusting for behavioral confounders.....it seems plausible that HIV-related immunosuppression could reduce the infection threshold needed for a productive systemic infection that leads to anti-HCV production as cellular mediated immunity may clear HCV without anti-HCV production [18]. A study of women also found that HIV infection increased the risk for HCV infection, and there was also a trend toward an increased risk with CD4 count <200 cells/mm"
RISK FACTORS FOR ACUTE HCV: "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/mm3 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/mm3"
NYC - Acute HCV Treatment/HIV+ MSM/HCV Screening/New HCV Therapies: "Determinants of Response to Pegylated Interferon and Ribavirin for Acute Hepatitis C Infection in Patients with Human Immunodeficiency Virus"......http://www.natap.org/2013/IDSA/IDSA_60.htm
HCV/MSM Sex Transmission in HIV+ in New York City......http://www.natap.org/2009/AASLD/AASLD_15.htm......"Acute HCV infection of HIV-infected MSM in New York City is sexually transmitted"
Epidemic of Acute HCV Among MSM in Europe and New York City........http://www.natap.org/2009/CROI/croi_62.htm.........The case-control study of 21 matched pairs showed an increased risk of HCV infection with: unprotected receptive anal intercourse with (p = 0.04) or without (p = 0.03) ejaculation; unprotected receptive oral sex with ejaculation (p = 0.03); use of sex toys (p = 0.03); "sex while high" (p = 0.01); and use of marijuana (p = 0.04).
Telaprevir in the Treatment of Acute HCV in HIV-infected Men......http://www.natap.org/2013/AASLD/AASLD_116.htm
Acute HCV Treatment/HIV+ MSM/HCV Screening/New HCV Therapies: "Determinants of Response to Pegylated Interferon and Ribavirin for Acute Hepatitis C Infection in Patients with Human Immunodeficiency Virus".......http://www.natap.org/2013/IDSA/IDSA_60.htm
In NYC: Liver Fibrosis During Acute HCV Infection of HIV-infected Men......http://www.natap.org/2007/CROI/croi_106.htm
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