Incidence of HCV Reinfection Among HIV-Positive MSM and Its Association With Sexual Risk Behavior: A Longitudinal Analysis

Abstract

Background Human immunodeficiency virus (HIV)-positive men who have sex with men (MSM) are at high risk of hepatitis C virus (HCV) reinfection following clearance of HCV, but risk factors specifically for reinfection have never been comprehensively assessed. Methods Using data from a prospective observational cohort study among HIV-positive MSM with an acute HCV infection (MOSAIC), the incidence of HCV reinfection following spontaneous clearance or successful treatment was assessed. A univariable Bayesian exponential survival model was used to identify risk factors associated with HCV reinfection. Results In total, 122 HIV-positive MSM who had a spontaneously cleared or successfully treated HCV infection between 2003 and 2017 were included. During a median follow-up of 1.4 years (interquartile range [IQR] 0.5–3.8), 34 HCV reinfections were observed in 28 patients. The incidence of HCV reinfection was 11.5/100 person-years and among those with reinfection, median time to reinfection was 1.3 years (IQR 0.6–2.7). HCV reinfection was associated with receptive condomless anal intercourse, sharing of sex toys, group sex, anal rinsing before sex, ≥10 casual sex partners in the last 6 months, nadir CD4 cell count <200 cells/mm3, and recent CD4 cell count <500 cells/mm3. Conclusions Incidence of HCV reinfection was high and strongly associated with sexual risk behavior, highlighting the need for interventions to reduce risk behavior and prevent HCV reinfections among HIV-positive MSM.

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

“…The lack of PWID becoming reinfected in our cohort demonstrates the ongoing risk of repeated HCV transmission in gbMSM who engage in high-risk sexual practices and sexualized substance use [9,11,12,18,28]. The published information about specific risk factors associated with reinfection among MSM is scarce [12,28].…”

“…The published information about specific risk factors associated with reinfection among MSM is scarce [12,28]. Recently, the MOSAIC cohort [18] in a smaller group of patients in the Netherlands found an association between some sexual practices, such as receptive condomless anal intercourse, sex toy sharing, group sex, or at least 10 casual sex partners in the last 6 months, and reinfection. In our study almost all reinfections occurred during unprotected anal intercourse, chemsex, and sex toy sharing, as reported elsewhere [11,18].…”

“…Recently, the MOSAIC cohort [18] in a smaller group of patients in the Netherlands found an association between some sexual practices, such as receptive condomless anal intercourse, sex toy sharing, group sex, or at least 10 casual sex partners in the last 6 months, and reinfection. In our study almost all reinfections occurred during unprotected anal intercourse, chemsex, and sex toy sharing, as reported elsewhere [11,18]. When we compare the reinfections and the new episodes that occurred in the last 2 years of our study, patients with reinfection presented a significantly higher proportion of STIs, and a higher non-significant trend of high prevalence of sexualized substance use, included slamming.…”

“…Studies have shown that people engaged in chemsex are more likely to engage in higher-risk sexual practices such as having sex with multiple partners, fisting and sharing sex toys, slamsex (injecting chemsex drugs), and to be diagnosed with concomitant sexually transmitted infections (STIs) [14][15][16][17]. This is worrisome, since all of these sexual behaviours associated with chemsex may facilitate the ongoing spread of HCV in this population [18].…”

A Feasibility Study to Increase Chronic Hepatitis C Virus RNA Testing and Linkage to Care among Clients Attending Homeless Services in Amsterdam, The Netherlands

“…To minimize this bias, we employed a penalized regression approach in which estimates from the sample were pulled towards more realistic ones assumed from prior knowledge [ 19 ]. For each risk factor, we assigned a prior distribution of the odds ratio (OR) based on the strength of association, as anticipated from previous investigation and expert consensus [ 20 ]. We assumed a noninformative prior for the intercept (i.e., uniform prior bound from −10,000 to 10,000).…”