Risk Factors for Sexual Transmission of Hepatitis C Virus Among Human Immunodeficiency Virus-Infected Men Who Have Sex With Men: A Case-Control Study

Abstract

Background. Since 2000, incidence of sexually acquired hepatitis C virus (HCV)-infection has increased among human immunodeficiency virus (HIV)-infected men who have sex with men (MSM). To date, few case-control and cohort studies evaluating HCV transmission risk factors were conducted in this population, and most of these studies were initially designed to study HIV-related risk behavior and characteristics.Methods. From 2009 onwards, HIV-infected MSM with acute HCV infection and controls (HIV-monoinfected MSM) were prospectively included in the MOSAIC (MSM Observational Study of Acute Infection with hepatitis C) study at 5 large HIV outpatient clinics in the Netherlands. Written questionnaires were administered, covering sociodemographics, bloodborne risk factors for HCV infection, sexual behavior, and drug use. Clinical data were acquired through linkage with databases from the Dutch HIV Monitoring Foundation. For this study, determinants of HCV acquisition collected at the inclusion visit were analyzed using logistic regression.Results. Two hundred thirteen HIV-infected MSM (82 MSM with acute HCV infection and 131 MSM without) were included with a median age of 45.7 years (interquartile range [IQR], 41.0–52.2). Receptive unprotected anal intercourse (adjusted odds ratio [aOR], 5.01; 95% confidence interval [CI], 1.63–15.4), sharing sex toys (aOR, 3.62; 95% CI, 1.04–12.5), unprotected fisting (aOR, 2.57; 95% CI, 1.02–6.44), injecting drugs (aOR, 15.62; 95% CI, 1.27–192.6), sharing straws when snorting drugs (aOR, 3.40; 95% CI, 1.39–8.32), lower CD4 cell count (aOR, 1.75 per cubic root; 95% CI, 1.19–2.58), and recent diagnosis of ulcerative sexually transmitted infection (aOR, 4.82; 95% CI, 1.60–14.53) had significant effects on HCV acquisition.Conclusions. In this study, both sexual behavior and biological factors appear to independently increase the risk of HCV acquisition among HIV-infected MSM.

Emerging viral STIs among HIV-positive men who have sex with men: the era of hepatitis C virus and human papillomavirus

“…Of particular concern is the increased reporting of injection drug use (IDU) and needle-sharing among MSM at sex parties in the UK, also referred to as slamming 25. Previous studies investigating determinants of acute HCV among MSM typically had 10%–20% of MSM reporting IDU 9 18 21. Increasing popularity of IDU will provide an alternative more efficient mode of HCV transmission that further fuels the ongoing HCV epidemic among MSM.…”

“…Rapid and irreversible immunological deterioration of the gastrointestinal mucosal barrier—the portal of entry for sexually acquired HCV—might increase host susceptibility to small inoculums of HCV, even in HIV-infected MSM with preserved CD4 counts 27. The latter could also explain the conflicting result regarding increased sexual acquisition of HCV with lower CD4 count (or CD4 nadir) in blood 7 18 19. HIV-positive MSM might also be more likely to shed HCV RNA in semen compared with men who are HIV negative as a consequence of higher HCV viral loads in blood 22 23.…”

The effects of free condom distribution on HIV and other sexually transmitted infections in men who have sex with men

“…HIV-positive individuals acquired the infection at age 42.6 years, and acute infection could be cleared spontaneously (at rate γ), or become chronic. 20 The acute and chronic stage were symptomatic (s) or asymptomatic. 12,21 Sexually transmitted HCV is only found among HIV-infected MSM, who have a reduced life expectancy compared to healthy males, reducing the number of years lost due to HCV.…”

Chemsex. Un fenómeno emergente

“…Es en HSH donde se ha dado la mayor proporción de nuevos diagnósticos de VIH en Europa en el año 2013, con un total de 42% (Cornejo, Díaz, Díez y Valín, 2015). Asimismo, se ha descrito una elevada incidencia de reinfección por VHC en HSH de diferentes ciudades europeas, alcanzando tasas cercanas al 25% (Ingiliz et al, 2016) con distintos factores de riesgo independientes: sexo anal sin protección, actividad sexual en el contexto de consumo de drogas estimulantes, prácticas sexuales de riesgo o sexo en grupo (Vanhommerig et al, 2015), características presentes en la práctica de chemsex.Con respecto a las drogas utilizadas en chemsex, la mefedrona destaca con una prevalencia de consumo descrita de hasta un 90% (Bourne et al, 2014). Esta sustancia, como otras catinonas sintéticas, cuenta con efectos psicoactivos y simpaticomiméticos similares a las anfetaminas, además de poseer propiedades entactógenas tales como intensificación sensorial, aumento de sociabilidad, desinhibición y excitación sexual.…”

“…Es en HSH donde se ha dado la mayor proporción de nuevos diagnósticos de VIH en Europa en el año 2013, con un total de 42% (Cornejo, Díaz, Díez y Valín, 2015). Asimismo, se ha descrito una elevada incidencia de reinfección por VHC en HSH de diferentes ciudades europeas, alcanzando tasas cercanas al 25% (Ingiliz et al, 2016) con distintos factores de riesgo independientes: sexo anal sin protección, actividad sexual en el contexto de consumo de drogas estimulantes, prácticas sexuales de riesgo o sexo en grupo (Vanhommerig et al, 2015), características presentes en la práctica de chemsex.…”