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Syphilis, Gonorrhea Tied to HCV in MSM and Trans Women With HIV
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IDWeek, October 2-6, 2019, Washington, DC
Mark Mascolini
A study of 876 US HIV-positive men who have sex with men (MSM) and trans women linked two sexually transmitted infections (STIs) to HCV infection [1]. Acute syphilis proved more frequent in people with newly diagnosed or chronic HCV, and pharyngeal gonorrhea occurred more often in people with than without a history of HCV [1]. HCV incidence in this cohort at Montefiore Medical Center in the Bronx, New York stood at 1.5% through 34 months of follow-up, while prevalence measured 2.7%.
Because HCV and HIV infection share several risk factors, researchers in the Bronx aimed to assess HCV screening, prevalence, incidence, and reinfections and to chart their relationships to other STIs in HIV-positive MSM and trans women attending Montefiore Medical Center outpatient clinics. This retrospective analysis focused on MSM and trans women seen over 34 months, from January 2016 through October 2018.
The 876 HIV-positive people assessed had a median age of 42 (range 18 to 75), 47% were non-Hispanic black, 33% Hispanic, and 14% white. A large majority, 80%, had attained HIV suppression with antiretroviral therapy.
Among 850 people with known HCV status, 36 (4.2%) had a positive HCV antibody test at any time, including 23 people (2.7%) at baseline and 13 with a new positive HCV antibody test (for a 34-month incidence of 1.5%). All 13 people with a new positive HCV test were sexually active, none injected drugs, and 6 were symptomatic with an elevated liver function test. Among 827 people negative for HCV antibody at baseline, 615 (74%) retested at least once and 260 (31%) retested more than once over a median interval of 12 months. No one became reinfected with HCV.
Among other STIs for which these people got tested, acute syphilis proved significantly more common in participants with newly diagnosed HCV (5 of 13, 38.5%; P = 0.002) or chronic HCV (6 of 21, 28.6%; P = 0.020) than in those testing negative for HCV (85 of 814, 10.4%). Pharyngeal gonorrhea proved significantly more frequent in people with a history of HCV than in those negative for HCV antibody (6 of 14 or 42.9% versus 70 of 500 or 14.0%, P = 0.003).
People tested for extragenital gonorrhea of chlamydia were more likely to get rescreened for HCV during the study period. But almost 1 in 5 participants (18.8%) with extragenital gonorrhea or chlamydia testing did not get retested for HCV. Compared with other racial/ethnic groups, non-Hispanic blacks had similar rates of new pharyngeal chlamydia, rectal gonorrhea, and acute syphilis--and higher rates of all other new STIs tested for.
The Montefiore team proposed that unexplained liver function test elevation should prompt HCV testing in HIV-positive MSM and trans women. Clinicians should be aware that newly acquired syphilis signals higher risk of acute or chronic HCV. The researchers stressed that HCV infection may be a signal of pharyngeal gonorrhea, and they argued "there is room to improve extragenital gonorrhea/chlamydia testing."
Reference
1. Cooper JD, Beil RS, Zingman BS. Hepatitis C (HCV) testing and diagnosis and their relationship to sexually transmitted infection (STI) screening and new infections in a HIV+ men who have sex with men (MSM) outpatient cohort. IDWeek, October 2-6, 2019, Washington, DC. Abstract 357.
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