Behavioural, not biological, factors drive the HCV epidemic among HIV-positive MSM: HCV and HIV modelling analysis including HCV treatment-as-prevention impact

MacGregor, Louis; Martin, Natasha K.; Mukandavire, Christinah; Hickson, Ford; Weatherburn, Peter; Hickman, Matthew; Vickerman, Peter

doi:10.1093/ije/dyx075

Cited by 26 publications

(23 citation statements)

References 47 publications

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“…Although we found an association between virus phylogeny and the traits of HIV‐seropositivity and age within cluster 4, this was not observed for the other three clusters. The overall lack of structure for HIV status within the clusters supports the notion that behavioural factors may be more critical than biological factors for driving the HCV epidemic amongst MSM, as modelling studies have predicted . For HIV‐negative individuals, it seems implausible that PrEP itself should increase HCV susceptibility.…”

Section: Discussionmentioning

confidence: 61%

Transmission of hepatitis C virus in HIV‐positive and PrEP‐using MSM in England

Bradshaw

Vasylyeva

Davis

et al. 2020

Journal of Viral Hepatitis

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We sought to characterize risk factors and patterns of HCV transmission amongst men who have sex with men (MSM). MSM with recently acquired HCV (AHCV) were prospectively recruited ('clinic cohort') between January and September 2017. Clinical data and risk behaviours were identified and blood obtained for HCV whole genome sequencing. Phylogenetic analyses were performed, using sequences from this cohort and two other AHCV cohorts, to identify transmission clusters. Sixteen (40.0%) men in the clinic cohort were HIV‐negative MSM. HIV‐negative MSM were younger than HIV‐positive MSM; most (81.3%) had taken HIV PrEP in the preceding year. Eighteen men (45.0%) reported injection drug use; most (34, 85.0%) reported noninjection drug use in the last year. Most in both groups reported condomless anal sex, fisting and sex in a group environment. Few (7, 17.5%) men thought partners may have had HCV. There were 52 sequences in the HCV genotype 1a phylogeny, 18 from the clinic cohort and 34 from other AHCV cohorts; 47 (90.4%) clustered with ≥1 other sequence. There were 7 clusters of 2‐27 sequences; 6 clusters contained HIV‐negative and HIV‐positive MSM and 1 cluster only HIV‐positive MSM. Four of these clusters were part of larger clusters first described in 2007. PrEP‐using MSM are at risk of HCV, sharing similar risk factors to HIV‐positive MSM. Phylogenetics highlights that PrEP‐using and HIV‐positive MSM are involved in the same HCV transmission networks. Few men demonstrated HCV awareness and risk reduction strategies should be expanded.

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Section: Discussionmentioning

confidence: 61%

Transmission of hepatitis C virus in HIV‐positive and PrEP‐using MSM in England

Bradshaw

Vasylyeva

Davis

et al. 2020

Journal of Viral Hepatitis

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“…Mother-to-child transmission of HCV results in some individuals entering the model chronically infected. This occurs at a rate dependent on the number of HCV-infected women of childbearing age (modelled as [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] and their HIV co-infection prevalence 14 . Once infected, individuals either spontaneously clear their infection, and become susceptible again, or develop lifelong chronic infection.…”

Section: Model Descriptionmentioning

confidence: 99%

“…Similarly, we were unable to include HCV epidemics among MSM within our model due to a scarcity of information around prevalences globally. However, studies indicate that although transmission among MSM is much higher than among heterosexual couples, incidence and prevalence is still low compared with PWID 31 and likely contributes little to the epidemic in comparison 32 .…”

Section: Strengths and Limitationsmentioning

confidence: 99%

The contribution of injection drug use to hepatitis C virus transmission globally, regionally, and at country level: a modelling study

Trickey

Fraser

Lim

et al. 2019

The Lancet Gastroenterology & Hepatology

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166

125

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, +44 (0) 117 928 7383 Implications of all the available evidence This modelling indicates the substantial contribution that injecting drug use makes to the global HCV epidemic. For many settings, scaling up HCV prevention and treatment interventions for people who inject drugs, including needle and syringe provision and opioid substitution therapy, will be essential to meet World Health Organization 2030 elimination targets.

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“…In fact, an increasing incidence of sexual HCV transmission has been observed in large European, North American and Asiatic cities, although at a lower level than in HIV‐positive MSM . Therefore, it has been suggested that all MSM at high risk (especially those receiving pre‐exposure prophylaxis for HIV, or practicing slamming) should be screened for HCV infection and other STIs, and should be the focus of prevention efforts . Commercial sex workers are prioritized for HCV screening by WHO, as they are vulnerable groups at high risk for STIs with poor access to the healthcare system .…”

Section: Discussionmentioning

confidence: 99%

Community‐based screening of hepatitis C with a one‐step RNA detection algorithm from dried‐blood spots: Analysis of key populations in Barcelona, Spain

Saludes

Folch

Morales-Carmona

et al. 2017

Journal of Viral Hepatitis

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Alternative strategies are required to enhance the diagnosis of silent hepatitis C virus (HCV) infections in key populations at risk. Among them, HCV prevalence and bio-behavioural data are scarce for HIV-negative men who have sex with men (MSM) and men and trans-women sex workers. We sought to describe and assess the potential benefits of a community-based one-step HCV screening and confirmatory strategy for these populations in Barcelona. The screening strategy based on a real-time RT-PCR assay for HCV-RNA detection in dried-blood spots (DBS) was validated and implemented in addition to an antibody point-of-care test in a community centre. HCV prevalence was assessed, and bio-behavioural data were collected. The molecular assay was precise, reproducible, sensitive and specific. Four HIV-negative MSM reported being currently infected (0.75% HCV self-reported prevalence). Implementation of DBS testing was easy, and acceptability was >95%, but no silent HCV case was diagnosed (N = 580). High-risk sexual practices and drug use for sex were reported frequently. HIV prevalence was 4.7% in MSM and 10% in sex workers. Self-reported prevalence of other STIs ranged from 11.3% to 36.2%. In conclusion, HCV-RNA testing in DBS showed a good performance, but the assessed one-step strategy does not seem beneficial in this setting. Although no silent HCV infections were detected, the observed high-risk behaviours and prevalence of other STIs suggest that HCV spread should be periodically monitored among these populations in Barcelona by means of behavioural surveillance, rapid antibody testing and molecular confirmation in DBS.

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Behavioural, not biological, factors drive the HCV epidemic among HIV-positive MSM: HCV and HIV modelling analysis including HCV treatment-as-prevention impact

Abstract: Sexual behaviour patterns likely drive observed HCV infection patterns among HIV-positive MSM. Changes in these patterns could disseminate HCV amongst HIV-negative MSM, limiting the impact of targeting HCV treatment to HIV-diagnosed MSM.

Cited by 26 publications

References 47 publications

Transmission of hepatitis C virus in HIV‐positive and PrEP‐using MSM in England

Transmission of hepatitis C virus in HIV‐positive and PrEP‐using MSM in England

The contribution of injection drug use to hepatitis C virus transmission globally, regionally, and at country level: a modelling study

Community‐based screening of hepatitis C with a one‐step RNA detection algorithm from dried‐blood spots: Analysis of key populations in Barcelona, Spain

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