Gaining Greater Insight into HCV Emergence in HIV-Infected Men Who Have Sex with Men: The HEPAIG Study

OBJECTIVES: The HEPAIG study was conducted to better understand Hepatitis C virus (HCV) transmission among human immuno-deficiency (HIV)-infected men who have sex with men (MSM) and assess incidence of HCV infection among this population in France. METHODS AND RESULTS: Acute HCV infection defined by anti-HCV or HCV ribonucleic acid (RNA) positivity within one year of documented anti-HCV negativity was notified among HIV-infected MSM followed up in HIV/AIDS clinics from a nationwide sampling frame. HIV and HCV infection characteristics, HCV potential exposures and sexual behaviour were collected by the physicians and via self-administered questionnaires. Phylogenetic analysis of the HCV-NS5B region was conducted. HCV incidence was 48/10 000 [95% Confidence Interval (CI):43-54] and 36/10 000 [95% CI: 30-42] in 2006 and 2007, respectively. Among the 80 men enrolled (median age: 40 years), 55% were HIV-diagnosed before 2000, 56% had at least one sexually transmitted infection in the year before HCV diagnosis; 55% were HCV-infected with genotype 4 (15 men in one 4d-cluster), 32.5% with genotype 1 (three 1a-clusters); five men were HCV re-infected; in the six-month preceding HCV diagnosis, 92% reported having casual sexual partners sought online (75.5%) and at sex venues (79%), unprotected anal sex (90%) and fisting (65%); using recreational drugs (62%) and bleeding during sex (55%). CONCLUSIONS: This study emphasizes the role of multiple unprotected sexual practices and recreational drugs use during sex in the HCV emergence in HIV-infected MSM. It becomes essential to adapt prevention strategies and inform HIV-infected MSM with recent acute HCV infection on risk of re-infection and on risk-reduction strategies

Main characteristics of the 80 HIV-infected MSM at acute HCV infection diagnosis reported by physicians, medical questionnaire, HEPAIG study, 2006–2007.

<p>Note. Data are no. (%) of patients or median values (inter-quartile range); MSM, men who have sex with men; HAART, highly active antiretroviral treatment; STI, sexually transmitted infection; ALT, alanine aminotransferase; ULN, upper limit of normal; ^a<50 copies/mL; ^bseveral possible answers; ^canti-HCV (+) within one year after anti-HCV (-) or HCV RNA (+) within one year after both documented anti-HCV (-) and HCV RNA (-); ^dHCV RNA (+) either: i) within one year after two documented HCV RNA (-), or, ii) with symptoms of acute hepatitis and ALT level >10xULN within one year after regular controls of normal ALT (other causes excluded); ^epossible acute HCV infection following primary infection with confirmed viral clearance.</p

HIV and HCV serologic status of sexual male partners and sexual practices with regular and casual partners in the six months before acute HCV infection diagnosis in HIV-infected men who have sex with men (self-administered questionnaires, HEPAIG study, 2006–2007).

<p>Note. Data are no (%) of patients; BDSM, bondage, discipline, sadism, masochism.</p

Drugs consumptions in the six months before acute HCV infection diagnosis in the 53 HIV-infected MSM with self-administered questionnaire, HEPAIG study, 2006–2007.

<p>Note. Data are no. (%) of patients. MDA, 3–4 methylene dioxy-amphetamine; GHB, gamma hydroxy butyric acid; ^aincluding anxiolytic, hypnotic or antidepressant; ^bseveral possible answers; ^cuse at least 10 times during the six-month period</p