Sexually acquired hepatitis C virus infection: a review

Abstract

Sexually acquired hepatitis C virus (HCV) infection remains a public health problem, with significant disease burden primarily in HIV-positive men who have sex with men (MSM). Over the past decades, the epidemic of sexually transmitted HCV infection has continued to expand and the epidemiology of HCV in HIV has changed significantly. In the post-combination antiretroviral therapy era, sexual network characteristics within the specific core group of MSM with increased sexual risk behaviours, including serosorting on the basis of HIV-positive status and intense mucosally traumatic sexual practices, confer increased HCV acquisition and transmission. This review summarizes the current epidemiology of sexually acquired HCV infection and the clinical and immunological contexts of acute HCV infection, and describes the biological, social, and behavioural factors that have facilitated permucosal transmission of HCV in MSM. While the advent of direct-acting antivirals has improved treatment responses significantly, sexually transmitted HCV reinfections occur in a substantial proportion of HIV-positive MSM following clearance of a primary infection. Effective strategies and preventive interventions that are tailored to the MSM communities to facilitate the control of sexually acquired HCV infection cannot be overemphasized.

Hepatitis C Guidance 2019 Update: American Association for the Study of Liver Diseases–Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection

“…Because use of allografts from HCV‐viremic donors in HCV‐negative recipients is a recent development in transplant medicine, there are no data on possible long‐term hepatic and extrahepatic adverse effects associated with HCV exposure, even among those cured of the infection. Allograft recipients who are HCV viremic can potentially sexually transmit the virus to their partner(s), particularly among MSM …”

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

“…Globally, approximately 25% of cases of cirrhosis and HCC are attributed to HCV 4. HCV primarily is a bloodborne pathogen but the increasing number of HIV-positive MSM with acute HCV diagnosed in the early 2000s suggested that its epidemiology was changing 5. Using a phylogenetic approach, the independently reported HCV outbreaks in various large cities across Europe proved to be part of one large international MSM-specific HCV transmission network 6.…”

“…HIV-negative MSM with sexually acquired HCV often report HIV-positive sexual partners,15 29 31 continuous introductions of HCV among the population without HIV might eventually result in an expanding HCV epidemic irrespective of HIV status. The increased popularity of Internet, mobile phone geosocial networking applications, MSM tourism and circuit (sex) parties may have provided an ideal platform for high-risk HIV-positive and HIV-negative MSM to extend their sexual networks 5 32. The formation of highly interconnected high-risk sexual networks may partly explain the successful expansion and rapid international dissemination of newly introduced STIs in recent years 6…”

Introductory Chapter: The Latest Knowledge

“…Some studies have shown that the transmission rates of HCV as a STI is very low among heterosexual couples. Similarly, the rate of sexually transmited HCV infection in HIV-negative MSM is low [40].…”

“…Some behaviors including having multiple sex partners, sexual intercourse without condom use, illicit drug use, sharing of injected equipment's, and alcohol use are generally associated with a higher prevalence of HIV/STIs [5]. High-risk behaviors such as serosorting and chemsex may increase the rate of sexually transmited HCV [40].…”