Increase in diagnosed newly acquired hepatitis C in HIV-positive men who have sex with men across London and Brighton, 2002-2006: is this an outbreak?

Abstract

Increase in diagnosed newly acquired hepatitis C in HIV-positive men who have sex with men across London and Brighton, 2002-2006: is this an outbreak?

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

“…HCV prevalence found among HIV-negative MSM was significantly lower (0.4%) in this study [30]. Also in London, the estimated annual HCV-incidence in HIVpositive MSM attending HIV and sexual health clinics rose by 20% each year to 12 per 1,000 person years in the first six months of 2006 [31]. To what extent HCV affects communities of HIV-positive MSM in other high-income countries remains unclear.…”

“…Early detection and treatment of HCV during the acute phase has been associated with a more favourable HCV treatment outcome [39]. Successful treatment prevents secondary infections to HIV-positive sexual contacts and could possibly prevent spill-over to the HIV-negative population [31]. In contrast to HCV screening of the general population, HCV screening of groups with an elevated risk, like IDU, is cost-effective [52].…”

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

“…Although heterosexual transmission of HCV is uncommon, the higher levels of HCV RNA seen in the setting of HIV infection may facilitate transmission [154,155], particularly in the presence of other sexually transmitted infections such as infectious syphilis. This is of particular concern in the light of the recent rise of syphilis cases within the HIV community [1,3,[156][157][158][159][160][161]. There have been reports from several European countries, Australia and the USA of hepatitis C transmission within the homosexual HIV community linked to possible sexual transmission and/ or use of noninjecting recreational drugs, particularly snorting cocaine.…”

“…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.…”

“…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].…”