Emerging viral STIs among HIV-positive men who have sex with men: the era of hepatitis C virus and human papillomavirus

Abstract

The number of infectious disease outbreaks and the number of unique pathogens responsible have significantly increased since the 1980s. HIV-positive men who have sex with men (MSM) are a vulnerable population with regards to the introduction, spread and clinical consequences of (newly introduced) STIs. After the introduction of combination antiretroviral treatment (cART), the incidence of sexually acquired hepatitis C virus (HCV) infection and human papillomavirus (HPV)-induced anal cancers have significantly increased among HIV-positive MSM. The introduction and expansion of HCV is the result of increased sexual risk behaviour and sexually acquired mucosal trauma within large interconnected networks of HIV-positive MSM in particular. With the availability of cART, postexposure and pre-exposure prophylaxis (PEP and PrEP) and direct-acting antivirals (DAAs) for HCV, less concern for HIV and HCV might require a new approach to develop effective behavioural intervention strategies among MSM. The marked rise in HPV-induced anal cancers can be ascribed to the long-term immunologic defects in an ageing population affected by HIV. More evidence with regards to effective treatment options for anal dysplastic lesions and the usefulness of anal malignancy screening programmes is urgently needed. Most anal cancers in the future generation of HIV-positive MSM could be prevented with the inclusion of boys in addition to girls in current HPV vaccination programmes.

Acute hepatitis C infection among adults with HIV in the Netherlands between 2003 and 2016: a capture–recapture analysis for the 2013 to 2016 period

“…HCV infections are generally uncommon in the Netherlands, with a chronic HCV prevalence of < 0.2% in 2016 [4]. However, an increase in the number of acute HCV infections and reinfections among men who have sex with men (MSM) who are human immunodeficiency virus (HIV)-positive has been reported since early 2000 [5][6][7]. Detection, diagnosis and registration of acute HCV infections are crucial to measure trends in the epidemic and to plan appropriate public health and clinical interventions, such as prevention programmes for those at risk, targeted testing, increasing treatment uptake, and contact tracing to reduce subsequent transmission.…”

Performance of ANTI‐HCV testing in dried blood spots and saliva according to HIV status

“…On the other hand, sexual activities such as anal intercourse were more common among those who were HIV‐infected, while lack of condom use was highly cited by HCV monoinfected and healthy subjects. A study in men who have sex with men showed an increase in HCV cases in HIV + individuals, mainly due to the practice of unprotected anal sex . Some studies have shown that high‐risk populations, such as individuals who have received transfusion and sexually at‐risk individuals, may present falsely reactive results for anti‐HCV detection, which could be the product of cross‐reactivity with other infections, such as HIV or HBV …”

“…A study in men who have sex with men showed an increase in HCV cases in HIV + individuals, mainly due to the practice of unprotected anal sex. 29 Some studies have shown that high-risk populations, such as individuals who have received transfusion and sexually at-risk individuals, may present falsely reactive results for anti-HCV detection, which could be the product of cross-reactivity with other infections, such as HIV or HBV. [30][31][32] Anti-HCV testing in DBS and saliva demonstrated specificity above 90% in HCV and HIV monoinfected groups, which is similar to previous studies using DBS in chronic HCV cases 12,[23][24][25]33 and studies using the Salivette device in individuals with chronic hepatitis C and HIV-infected individuals.…”

Acute hepatitis C infection among adults with HIV in the Netherlands: a capture-recapture analysis

“…Hepatitis C virus (HCV) infections are generally uncommon in the Netherlands, with a chronic HCV prevalence of <0.2% [1]. However, an increase in the number of acute HCV infections and reinfections among men who have sex with men (MSM) who are HIV-positive has been reported since early 2000 [2][3][4]. Detection, diagnosis and registration of acute HCV infections are crucial to measure trends in the epidemic, and plan appropriate public health and clinical interventions, such as prevention programs for those at risk, targeted testing, increasing treatment uptake, and contact tracing to reduce subsequent transmission.…”