Impact of Sexualized Substance Use and Other Risk Practices on HCV Microelimination in gbMSM Living with HIV: Urgent Need for Targeted Strategies. Results of a Retrospective Cohort Study

Abstract

Introduction:The objective of the present study is to describe the incidence of recently acquired hepatitis C (RAHCV) in a large cohort of people living with HIV (PLWHIV) and sexualized drug use and other related risk behaviours. Methods: Observational study including all PLWHIV with a RAHCV episode between June 2005 and December 2019 at the Hospital Clinic of Barcelona, Spain. Incidence of RAHCV was determined per person calendar year (py) in those patients who were HCV RNA negative. Data were collected on high-risk sexual practices for HCV transmission focused on gay, bisexual and other men having sex with men (gbMSM). Results: A total of 340 RAHCV were diagnosed in 290 PLWHIV; 274 (94%) of them were gbMSM and developed 324 RAHCV, mainly since 2010 (90%). Overall incidence rate (IR) of RAHCV in gbMSM was 0.10 py (95% CI 0.09-0.11), with a 40% decreased observed since 2017 (IR 0.06, 95% CI 0.03-0.09 in 2019). Sixty reinfections were detected in 50 gbMSM (n = 244, 20%). The overall reinfection IR was 0.17 per py (95% CI 0.12-0.23) and the proportion of reinfection among total RAHCV increased to 47% cases in 2019, mainly in patients engaged in sexualized substance use (76%), unprotected anal intercourse (94%), sex partying (80%), fisting (43%), slamming (14%) and 60% of concomitant sexually transmitted infections (STIs). Conclusions: Despite RAHCV incidence decline in our cohort since 2017, HCV reinfection increased. High sexualized substance use and other risk behaviours are described in this context, indicating the need for public health tailored strategies to reduce this transmission and achieve HCV microelimination in gbMSM living with HIV.

Vulnerability Conditions in a Cohort of Men Who Have Sex with Men Who Engage in Chemsex in Barcelona City: a Cross-Sectional Study

“…Based on this, variables other than sharing injection materials, such as high-risk sexual practices, may be related risk factors for HCV infection. This hypothesis is supported by other publications (Berenguer et al, 2019;Martínez-Rebollar et al, 2015), and individuals who engage in chemsex are a target population to tailor strategies to achieve HCV microelimination (Martínez-Rebollar et al, 2021).…”

Impact of coronavirus disease 2019 epidemics on prevention and care for HIV and other sexually transmitted infections

“…These results are in contrast with those from models predicting increased nondiagnosed cases of hepatitis C in Spain during the COVID-19 epidemics [24] but they are in accordance with recent real data from the USA [25]. De novo hepatitis C diagnosis in our setting has been more commonly linked to high-risk sexual practices and sexualized substance use [26]. It is possible that these practices may have been more affected by the epidemic than other sexual encounters.…”

Hepatitis C Virus Reinfection in People With HIV in Taiwan After Achieving Sustained Virologic Response With Antiviral Treatment: The RECUR Study

“…Fourth, compared with the suboptimal efficacy and tolerance of IFN, the awareness of potent and safe DAAs to manage HCV reinfection in HIV-positive patients may reduce vigilance for the unsafe sex and shared injections that potentiate reinfection [ 36–39 ]. As observed in our cohort, studies from Germany, the Netherlands, and Spain indicated that the risk of HCV reinfection tended to increase in the era of DAAs among MSM with high-risk sexual behaviors regardless of HIV status [ 17 , 20 , 40 ].…”

“…Although the risk of HCV reinfection of our HIV-positive patients was much higher than that of the reference patients, we found that no baseline factors predicted HCV reinfection [ 21 ]. Multiple sex partners, unprotected anal intercourse, group sex, sharing sex toys, and amphetamine abuse in HIV-positive MSM and ongoing use of cocaine, methamphetamine, or heroin injection in HIV-positive PWID after achieving SVR were highly associated with HCV reinfection; these factors were evident in our HIV-positive patients with HCV reinfection [ 17 , 20 , 24 , 30 ]. Furthermore, studies also showed that a new diagnosis of sexually transmitted infection or syphilis during post-SVR 12 follow-up was highly associated with risk of HCV infection among HIV-positive patients [ 23 , 31 ].…”