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HCV Testing and Diagnosis and their relationship to STI Screening and New Infections in a HIV+ MSM Outpatient Cohort - Syphilis, Gonorrhea Tied to HCV in MSM and Trans Women With HIV
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Reported by Jules Levin
ID Week 2019; October 2-6, 2019; Washington, DC, USA
Joseph D. Cooper, MD1,3
Robert S. Beil, MD2,3
Barry S. Zingman, MD1,3
1Division of Infectious Diseases
2Division of General Internal Medicine
3Montefiore Medical Center and Albert Einstein College of Medicine
IDWeek: Syphilis, Gonorrhea Tied to HCV in MSM and Trans Women With HIV- Mark Mascolini (10/4/19)
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.
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.
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."
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