Hepatitis C Is an Emerging Infection Among HIV-Infected MSM

During the past 13 years, the incidence of HCV infection among men who have sex with men increased 18-fold in the Swiss HIV Cohort Study.

Hepatitis C virus (HCV) infection is common among HIV-infected individuals, especially injection-drug users (IDUs) and hemophiliacs. However, during the past few years, HIV-infected men who have sex with men (MSM) have also been identified as a high-risk group for HCV infection (JW AIDS Clin Care Aug 8 2011). To assess changes in the incidence of HCV infection among these various risk groups, investigators looked at 13 years' worth of data (1998–2011) from the Swiss HIV Cohort Study. Study participants were screened for HCV infection at entry into the cohort and every 2 years thereafter.

At study enrollment, 3% of MSM, 92% of IDUs, and 11% of heterosexuals were already HCV positive. Of the 8709 study participants who were HCV negative at baseline, 6534 had follow-up HCV serology results and were included in this analysis; 51% were MSM, 2% IDUs, and 47% heterosexuals. During follow-up, 3% of MSM, 33% of IDUs, and 0.8% of heterosexuals experienced an HCV seroconversion. The incidence rate among MSM increased from 0.2 per 100 person-years in 1998 to 4.1 per 100 person-years in 2011, an 18-fold increase. In contrast, the incidence rate among IDUs decreased, from 13.9 to 2.2 per 100 person-years. Among MSM, inconsistent condom use and a past history of syphilis were significantly associated with HCV seroconversion.

Comment: HIV-infected MSM are at high risk for HCV coinfection and should be screened at entry into care. Those who are HCV negative should undergo liver function testing every 6 months and HCV antibody testing every year, as recommended by the European AIDS Treatment Network (JW AIDS Clin Care Feb 28 2011 and May 25 2012). Prompt recognition of HCV infection may allow patients to be treated during acute HCV infection, when response to therapy may be greater.

— Carlos del Rio, MD

Published in Journal Watch HIV/AIDS Clinical Care September 24, 2012

Citation(s):

Wandeler G et al. Hepatitis C virus infections in the Swiss HIV Cohort Study: A rapidly evolving epidemic. Clin Infect Dis 2012 Sep 12; [e-pub ahead of print]. (http://dx.doi.org/10.1093/cid/cis694)

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