Sexual contact most likely cause of HCV transmission in HIV-infected MSM

Fierer D. MMWR. 2011;60:945-950.

Issue: August 2011

Sexual transmission was the most likely cause of hepatitis C virus transmission among HIV-infected men who have sex with men in New York City, according to findings published in a recent Morbidity and Mortality Weekly Report.

"Transmission of the virus through sex, in the absence of injection drug use, has not been well understood," Deborah Holtzman, PhD, of the CDC’s Division of Viral Hepatitis, told Infectious Disease News. "This report provides evidence of sexual transmission of HCV among MSM who also are living with HIV. Transmission of HCV in this population is especially concerning because infection with HIV may lead to an increased likelihood of HCV being transmitted sexually, and coinfection with HIV also is known to accelerate HCV disease progression."

Between October 2005 and December 2010, researchers evaluated 74 HIV-infected MSM from New York City who reported no injection-drug use but had newly elevated alanine transferase (ALT) levels and a positive HCV antibody test result.

In a matched case-control analysis, researchers found HIV-infected MSM newly infected with HCV were more likely than HIV-infected MSM without HCV to have had receptive (OR=24.87) or insertive (OR=2.62) anal intercourse without condom use; to engage in group sex (OR=19.28); engage in sex while taking drugs (OR=11.37); previously had syphilis (OR=8.80) or gonorrhea (OR=5.02); and had sex while high on methamphetamine (OR=26.80). Overall, researchers determined that HCV infection was most strongly associated with sexual contact while using methamphetamine (OR=28.56). This was followed by receptive anal intercourse without condom use (OR=23.00).

"Clinicians should screen all patients newly diagnosed with HIV, including MSM, for HCV; clinicians also should consider routine HCV testing of HIV-infected MSM, especially for those with high-risk sexual behaviors or ulcerative STDs," Holtzman said. "In addition, clinicians should counsel and remind their patients that unprotected sex between HIV-infected partners can transmit other infections, including HCV. It is important for HIV-infected MSM to realize that having unprotected sex with other HIV-infected men can lead to infection with HCV, as well as infection with other STDs. The best way for HIV-infected MSM to prevent sexual transmission of any infections is through abstinence or by using condoms consistently and correctly," she said.

Efforts to raise awareness, improve surveillance and increase testing are needed to better understand the role of sexual transmission in HCV infection incidence nationwide, Holtzman said. – by Ashley DeNyse

Disclosure: The researchers report no relevant financial disclosures.

Follow InfectiousDiseaseNews.com on Twitter.