The prevalence of hepatitis C virus (HCV) infection in HIV-positive men who have sex with men in San Diego has increased over the past 15 years, especially among men taking non-medications, but use of Methamphetamine, 2016 Liver Meeting AASLD this month in Boston. Another study by the same researchers found that post-treatment of reinfection is also a concern in this population.
Since the early 2000s, researchers in the UK and other European countries have begun reporting acute HCV infection groups among HIV-positive homosexuals and bisexual men in major cities; Similar outbreaks have been observed in the cities of Australia and the United States. A number of risk factors were involved - including anal sex without a condom, fisting, group sex, sexually transmitted infections and non-injectable drugs - but these were not consistent across studies. Sexual transmission of HCV is uncommon in HIV-positive men who have sex with men.
The researchers did a retrospective cohort analysis of the incidence of HCV in HIV-positive men who have sex with men attended the Owen Clinic UCSD, San Diego's largest HIV clinic from 2000 to 2015.
The analysis included 2,396 clinical clients who had a negative HCV antibody test at baseline. The median age was 39 years, 70% were Caucasian and 11% were black. Only 6.5% reported having ever injected drugs, but 58% reported using methamphetamine.
An incident or new infection was defined as an anti-HCV positive or HCV RNA test after a negative test. Participants were tested for HCV a median of three times with a median 1.2-year interval between tests.
A total of 150 seroconversions of HCV occurred during 12,565 person-years of follow-up, obtaining an incidence rate of 1.20 per 100 person-years (94% CI: 1.01; 1.39). New cases of HCV were identified on average 10.7 years after HIV diagnosis and 3.7 years after the first HCV negative test.
Men with a new HCV infection did not differ from the entire cohort in terms of age and race / ethnicity. However, newly infected males were significantly more likely than uninfected males to have injected drugs (18 vs 7%) have used methamphetamine (82 vs. 58%).
The incidence of HCV was significantly higher in men who reported injecting drug use than those who did not (2.8 vs. 0.97 per 100 person-years). Similarly, HCV infection was significantly more frequent among men reporting methamphetamine use than those who did not (1.52 vs. 0.52 per 100 person-years).
The overall incidence of HCV has increased over time, from just 0.38 new infections per 100 person-years between 2000 and 2003, to 1.52 per 100 person-years between 2012 and 2015. New cases of HCV HCV among men who have not injected methamphetamine While the incidence in men who used methamphetamine has increased dramatically over time. The incidence among men who have injected drugs increased sharply from 2000-2003 to 2004-2007 but then stabilized and decreased between 2008-2011 and 2012-2015 - which probably reflects an increase in harm reduction practices.
"These results suggest that the ever increasing incidence of HCV among HIV + MSM in San Diego," the researchers concluded. "These rates are similar to London and other major European cities, and double that seen in the multicenter American AIDS Cohort Study."
"This study also documented HCV infection among HIV + non-injecting MSM and a higher incidence of HCV among those who reported using methamphetamine," they added. "Continue to work to determine the trajectory and prevention of the epidemic is necessary to fight against the epidemic are necessary.
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