Evidence of a Large, International Network of HCV Transmission in HIV-Positive Men Who Have Sex With Men

Abstract

Background Since 2000, there has been a marked rise in acute hepatitis C virus (HCV) in HIV-positive men who have sex with men (MSM). We conducted an international phylogenetic study to investigate the existence of an HCV transmission network among MSM. Methods HIV-positive MSM diagnosed with recent HCV (n=226) in England (107), Netherlands (58), France (12), Germany (25) and Australia (24) between 2000 and 2006 were enrolled into a molecular phylogenetic study. Using real-time PCR, the NS5B region of the HCV genome (436 bp) was amplified, sequenced and compared with unrelated NS5B sequences. Results NS5B sequences were obtained from 200 (89%) cases. Circulating HCV genotypes were 1a (59%); 4d (23%), 3a (11%), 1b (5%), and 2b/c (3%). Phylogenetic analysis revealed 156 (78%) sequences that formed 11 clusters (bootstrap value >70%) containing between 4 and 37 individual sequences. Country mixing was associated with larger cluster size (17 vs 4.5 sequences; p=0.03). ‘Molecular clock’ analysis indicated that the majority (85%) of transmissions occurred since 1996. Discussion Phylogenetic analysis revealed a large international network of HCV transmission among HIV-positive MSM. The rapid spread of HCV among neighboring countries is supported by the large proportion (74%) of European MSM infected with an HCV strain co-circulating in multiple European countries; the low evolutionary distances among HCV isolates from different countries; and the trend toward increased country mixing with increasing cluster size. Temporally, this epidemic coincides with the introduction of highly active anti-retroviral therapy and associated increases in sexual risk behaviors. International collaborative public health efforts are needed to mitigate HCV transmission among this population.

Viral hepatitis among men who have sex with men, epidemiology and public health consequences

“…This is not only the case in Europe, for example, in the United Kingdom and the Netherlands, but also in other countries around the globe, like Japan [19][20][21]. For HAV and HCV, several studies have shown that there is ongoing transmission of several different MSM-specific viral strains within MSM networks [11,22]. Thus far, research indicates that just one HBV strain circulates among MSM in high-income countries.…”

British HIV Association guidelines for the management of coinfection with HIV‐1 and hepatitis B or C virus 2010

“…Although hepatitis A is thought to be sexually transmitted in MSM, it is linked to fisting and oro-anal contact [8][9][10], in which case condoms are unlikely to offer protection. There is an epidemic of acute HCV infection amongst HIV-infected MSM in the UK and Western Europe [1,2] linked with mucosal traumatic sexual practices and co-transmitted with other sexually transmitted infections, particularly syphilis and lymphogranuloma venereum (LGV) [3]. In many cases this seems to be related to unprotected sex between men who are both HIVpositive.…”

“…While the exact mode of transmission remains unclear, associations have been seen with HIV-positive status, recent sexually transmitted infections (syphilis, lymphogranuloma venereum and gonorrhoea), multiple sexual partners, unprotected anal intercourse and recreational drug use [2,3,155,[158][159][160][161]228]. …”

“…Over the past few years there have been increasingly recognized outbreaks of acute hepatitis C amongst MSM; while initially localized in cities with high MSM populations, cases are now being reported more widely and incidence rates appear to be still increasing [2,3,155,[158][159][160][161]228]. While the exact mode of transmission remains unclear, associations have been seen with HIV-positive status, recent sexually transmitted infections (syphilis, lymphogranuloma venereum and gonorrhoea), multiple sexual partners, unprotected anal intercourse and recreational drug use [2,3,155,[158][159][160][161]228].…”

“…In the disease-specific section of these guidelines we have demonstrated that there is an ongoing epidemic of acute HCV infection amongst HIV-infected men who have sex with men (MSM) in the UK and Western Europe [1,2] linked with mucosal traumatic sexual practices and co-transmitted with other sexually transmitted infections [3]. Early recognition of acute HCV infection is therefore important, as early treatment offers the best chance of viral clearance [4].…”