Trouble with Bleeding: Risk Factors for Acute Hepatitis C among HIV-Positive Gay Men from Germany—A Case-Control Study

Abstract

ObjectivesTo identify risk factors for hepatitis C among HIV-positive men who have sex with men (MSM), focusing on potential sexual, nosocomial, and other non-sexual determinants.BackgroundOutbreaks of hepatitis C virus (HCV) infections among HIV-positive MSM have been reported by clinicians in post-industrialized countries since 2000. The sexual acquisition of HCV by gay men who are HIV positive is not, however, fully understood.MethodsBetween 2006 and 2008, a case-control study was embedded into a behavioural survey of MSM in Germany. Cases were HIV-positive and acutely HCV-co-infected, with no history of injection drug use. HIV-positive MSM without known HCV infection, matched for age group, served as controls. The HCV-serostatus of controls was assessed by serological testing of dried blood specimens. Univariable and multivariable regression analyses were used to identify factors independently associated with HCV-co-infection.Results34 cases and 67 controls were included. Sex-associated rectal bleeding, receptive fisting and snorting cocaine/amphetamines, combined with group sex, were independently associated with case status. Among cases, surgical interventions overlapped with sex-associated rectal bleeding.ConclusionsSexual practices leading to rectal bleeding, and snorting drugs in settings of increased HCV-prevalence are risk factors for acute hepatitis C. We suggest that sharing snorting equipment as well as sharing sexual partners might be modes of sexual transmission. Condoms and gloves may not provide adequate protection if they are contaminated with blood. Public health interventions for HIV-positive gay men should address the role of blood in sexual risk behaviour. Further research is needed into the interplay of proctosurgery and sex-associated rectal bleeding.

Recent Hepatitis C Virus Infections in HIV-Infected Patients in Taiwan: Incidence and Risk Factors

“…1), which differ somewhat from the genotypes reported in Europe (genotypes 1a, 1b, 3a, and 4d) (42,44) and those circulating among HIV-infected IDUs in Taiwan (genotypes 1a, 3a, and 6a) (23). Although we could not exclude the possibility of nasal ingestion of cocaine or amphetamines, which was previously reported to be associated with acute HCV infection (35), the findings of different circulating HCV strains between IDU and MSM populations suggest that transmission networks of recent HCV infection in our study population might be different from those of IDUs and that sexual transmission is likely, given its association with recent syphilis.…”

“…In addition, ulcerated sexually transmitted infections (such as herpes simplex virus type 2 infection or syphilis) and rough sexual practices (such as fisting) can facilitate the sexual transmission of HCV (8,11,14,26,35). Given the increasing trends of recent HCV infections in MSM in developed countries in several continents, counseling for pre- venting HCV transmission should be included in the public health and clinical approach to provision of information, education, and communication for sexually transmitted infections.…”

Sexual transmission of hepatitis C virus among gay and bisexual men: a systematic review

“…25,26 Traumatic sexual practices, such as fisting, were also identified as a risk factor in five studies. 20,21,25,28,29 Longitudinal studies Sixteen studies were included ( Table 2).…”

Acute Hepatitis C Virus in an HIV Clinic: A Screening Strategy, Risk Factors, and Perception of Risk

“…9 In addition to classic risk factors for acute HCV among HIV-infected women and heterosexual men, reported risk factors among HIV-infected MSM include traumatic sexual practices (e.g., unprotected anal intercourse, use of sex toys, digital-manual insertion), and having a history of or concurrent STI. [10][11][12][13] Acute HCV outbreaks have been linked to core groups of MSM who are more likely to have multiple partners, and use recreational drugs such as methylenedioxymethamphetamine (ecstasy) and other noninjection stimulants, and erectile dysfunction medications. 11 Whether most HIV-infected MSM who engage in risk behavior are aware of these nonclassic risks for acute HCV is unclear.…”

“…Pooling may fail to detect specimens from patients with a low level of viremia, some of whom may be antibody-negative and infectious. 42 The BRQ did not include questions about serosorting-the practice of engaging in unprotected sex with others of the same HIV status-which has been proposed as an explanation for the disproportionate rise in acute HCV rates among HIV-infected MSM compared to HIV-uninfected men, 12 although enhanced susceptibility or increased subgroup risk could explain this. Future studies should also gather data about intrarectal drug delivery, which may traumatize mucosa and promote HCV transmission.…”