Hepatitis C Virus RNA Is Commonly Detectable in Rectal and Nasal Fluids of Patients With High Viremia

Abstract

Background Increasing numbers of hepatitis C virus (HCV) infections among men who have sex with men (MSM) are being observed in the Western world. The actual routes of HCV transmission during high-risk sex practices and associated drug use remain poorly understood. Methods Forty-seven patients with HCV were prospectively enrolled. Rectal and nasal swabs were collected to quantify HCV-RNA levels within rectal and nasal fluids. Contamination by occult rectal bleeding was excluded by guaiac paper test. Risk behavior was assessed by standardized questionnaires. Results Median age was 41.9 years, 89% were HIV positive (+) (42/47) and 85% (40/47) were male, 58% (23/40) of whom were MSM. Acute HCV infection was diagnosed in 32% (15/47) ,with all patients being HIV+MSM and 93% (14/15) having a documented history of sexually transmitted disease. Thirty-three (70%) patients had ≥1 HCV+ swab sample (HCV+SS; 48%, 22/46 rectal; 62%, 29/47 nasal), and contamination with blood was excluded in all patients. Individuals with HCV+SS had significantly higher serum HCV-RNA levels than patients with HCV-negative SS (6.28 [IQR, 0.85] log IU/mL vs 4.08 [2.45] log IU/mL; P < .001). Using ROC-curve analysis, serum HCV-RNA cutoffs for ruling in/out any HCV+SS were established at 6.02 log IU/mL and 4.02 log IU/mL, respectively. Conclusions HCV-RNA is commonly detectable in rectal and nasal fluids of both HIV+ and HIV-negative HCV patients with high serum HCV-RNA, independently of the suspected route of HCV transmission. Accordingly, high-risk sex practices and sharing of nasal drug-sniffing “tools” might be important HCV transmission routes, especially in patients with high serum HCV-RNA.

Adherence to Direct-Acting Antiviral Therapy in People Actively Using Drugs and Alcohol: The INCLUD Study

“…A unique aspect of our study was the inclusion of persons actively using drugs by injection and noninjection routes. Although IDU is a known risk factor for HCV transmission, noninjection drug and alcohol use are also very common, and these may present challenges to ensuring medication adherence, treatment completion [ 21 , 22 ], and potentially contribute to reinfection depending on drug administration route and other behaviors [ 35 ]. Stimulant injection has been identified as a risk factor for poor DAA adherence [ 7 , 9 ].…”

The ‘Viennese epidemic’ of acute HCV in the era of direct‐acting antivirals

“…In our study, we had very limited information on specific risk, since only information on the suspected route of HCV transmission was available. Nevertheless, previous studies have demonstrated that the vast majority of Austrian HCV-infected MSM engaged in sexualized drug use and condomless anal intercourse 9 -two well-established high-risk practices for HCV acquisition. Another typical marker for increased risk for HCV transmission is positive HIV status.…”

Outcomes of an HCV elimination program targeting the Viennese MSM population

“…This is in line with reports from other European centers describing a high incidence/prevalence of HCV infection [ 3 ], even in times of unrestricted access to direct-acting antiviral (DAA) treatment [ 4 ], not only in HIV-positive MSM but also in HIV-negative MSM, especially if they take pre-exposure prophylaxis (PrEP) [ 5 , 6 ]. Unprotected anal intercourse and nasal and/or intravenous drug use are considered major modes of transmission for HCV in MSM, and respective risk behavior is commonly observed in the Viennese MSM population [ 7 ]. Early treatment of HCV-infected MSM has been shown to be highly effective [ 1 ], even among patients with ongoing drug use [ 8 ].…”