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Hepatitis C Epidemic Mostly Confined to HIV Positive Gay Men in London

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HIV negative gay and bisexual men in London have a hepatitis C prevalence similar to that of the general population, confirming that outbreaks of sexually transmitted HCV among men who have sex with men are largely limited to those who are HIV positive, according to a report in the June 18, 2013, advance edition of HIV Medicine.

Starting in the early 2000s clinicians began to report outbreaks of apparently sexually transmitted hepatitis C virus (HCV) among HIV positive gay and bisexual men, first in large cities in the U.K. and continental Europe, and later in Australia and the U.S. These epidemics have been linked to several risk factors including unprotected anal sex, use of recreational drugs, and concurrent sexually transmitted infections.

People with HIV typically undergo regular liver function tests to monitor for potential antiretroviral drug toxicity. This can reveal elevated liver enzymes that on further analysis are found to signal unsuspected HCV infection. This has led some experts to suggest that perhaps HIV negative gay men also have a high rate of hepatitis C but are simply not getting tested for it.

Huw Price and colleagues from University College London and the U.K. Health Protection Agency conducted a study of HCV infection among HIV positive and negative men in London, which they describe as the first examination of the association between HIV and hepatitis C serostatus in a sample of men who have sex with men recruited in community settings.

A previous study looking at HIV negative men seen at sexual health clinics in the U.K. did not find an elevated hepatitis C rate.

Price's team analyzed data from 1121 participants in the Gay Men’s Sexual Health Survey, with a median age of 33 years (range 16 to 81 years). During 2008-2009 they completed short surveys about demographics and behavior, and donated an oral fluid sample for HIV, HCV, and syphilis antibody testing.

Results

  • The overall seroprevalence of hepatitis C antibodies was 2.1%.
  • HIV and syphilis antibodies was considerable higher (approximately 15% and 12%, respectively).
  • HCV was significantly more common among HIV positive compared with HIV negative men (7.7% vs 1.2%, respectively).
  • The rate among HIV negative men was statistically similar to the 0.67% rate for the U.K. general population.
  • Men with a history of syphilis had an even higher rate -- 12.2% -- compared with 1.7% among men who had never had syphilis.
  • HCV prevalence was also significantly higher among men who reported casual unprotected anal intercourse during the past year compared with those who did not (4.1% vs 1.2%, respectively).
  • There was no relationship between hepatitis C antibody status and other demographic variables including age, race/ethnicity, education level, or employment status.

"The seroprevalence of [HCV antibodies] in HIV negative [men who have sex with men] (1.2%) was higher, but not significantly higher, than that in the general population (0.67%)," the researchers concluded. "The [HCV] prevalence was significantly higher in those infected with HIV or with previous syphilis infection and in those reporting unprotected anal intercourse."

In short, they summarized, "In a community sample of [men who have sex with men] in London, we did not find any evidence of a large number of HIV negative MSM with evidence of exposure to HCV."

"Our findings support current British Association for Sexual Health and HIV guidelines recommending the provision of selective HCV testing in MSM according to individual risk profile," they added.

8/21/13

Reference

H Price, R Gilson, D Mercey, et al. Hepatitis C in men who have sex with men in London -- a community survey. HIV Medicine. June 18, 2013 (Epub ahead of print).