The prevalence of hepatitis C infection among HIV-positive gay men attending a large Amsterdam sexual health clinic is 18% and rising, reported Anouk Urbanus at the XVII International AIDS Conference in Mexico City on August 7th.
Anonymous surveys were conducted at the clinic in May 2007, November 2007 and April 2008. A total of 3125 people took part in the survey, but almost four-fifths were heterosexual men and women, amongst whom hepatitis C prevalence was low at 0.3%. Moreover, prevalence was also low among HIV-negative gay men at 0.4% (2 of 532 men).
However among HIV-positive gay men, 18% had hepatitis C (28 of 157 men). Comparing the results between the three surveys, prevalence rose from 15% to 17% and then to 21%. Just under a third of these men were unaware of their infection.
In multivariate analysis, hepatitis C infection in gay men was associated with being HIV-positive (OR: 38.4), fisting (OR 15.0) and injecting drug use (15.5). However it is important to note that only 18% of the co-infected gay men reported injecting drug use.
The question and answer session at the conference highlighted continued confusion and doubt among delegates surrounding the risk factors for hepatitis C infection, although numerous studies have identified an association with fisting. Moreover Kevin Fenton of the US Centers for Disease Control, the chair of the session, intervened to question the limited public health response to the outbreaks of hepatitis C in Europe. He noted that outbreaks of syphilis and LGV had been given a more concerted and aggressive response, and called for a greater sense of urgency.
Urbanus A. HCV is emerging as an STI among HIV-infected MSM: a threat to the MSM community? XVII International AIDS Conference, Mexico City, abstract THPDC203, August 7 2008.