title: Can current national surveillance systems in England and Wales monitor sexual transmission of hepatitis C among HIV-infected men who have sex with men?
abstract: BACKGROUND
  Recent reports suggest an increase in sexually-transmitted hepatitis C infection among HIV-infected men who have sex with men (MSM) in European cities. We investigated whether current national surveillance systems in England and Wales (E&W) are able to monitor sexual transmission of hepatitis C infection among HIV-infected MSM.
  
  
  METHODS
  Routine laboratory reports of hepatitis C diagnoses and data from sentinel hepatitis C testing surveillance were matched to HIV diagnosis reports to determine: (i) the number of MSM diagnosed with HIV and hepatitis C (1996-2003); (ii) the number of HIV-diagnosed MSM tested for hepatitis C and found to be positive at sentinel sites (2003).
  
  
  RESULTS
  (i) Between 1996-2003, 38,027 hepatitis C diagnoses were reported; 25,938 (68%) were eligible for matching with HIV diagnoses. Thirty-one men (four in London) had both a HIV and hepatitis C diagnosis where the only risk was sex with another man. Numbers of "co-diagnosed" MSM increased from 0 in 1996 to 14 in 2003. The majority of MSM (22/31) tested hepatitis C positive after HIV diagnosis. (ii) Of 78,058 test results from sentinel hepatitis C testing sites in 2003, 67,712 (87%) were eligible for matching with HIV diagnoses. We identified 242 HIV-diagnosed MSM who did not inject drugs who tested for hepatitis C in 2003; 11 (4.5%) tested hepatitis C positive (95% CI: 2.3%-8.0%). Applying this percentage to all MSM seen for HIV-related care in E&W in 2003, an estimated 680 MSM living with diagnosed HIV would have tested positive for sexually-transmitted hepatitis C (95% CI: 346-1208).
  
  
  CONCLUSIONS
  Matching routine laboratory reports of hepatitis C diagnoses with HIV diagnoses only identified 31 HIV infected MSM with sexually-transmitted hepatitis C infection. Clinical studies suggest that this is an underestimate. On the other hand, matching sentinel surveillance reports with HIV diagnoses revealed that in E&W in 2003 nearly 5% of HIV-diagnosed MSM tested hepatitis C positive where the only risk was sex with another man. Reports of sexually-transmitted hepatitis C infection were not confined to London. Enhanced surveillance is needed to monitor sexually-transmitted hepatitis C among HIV-infected MSM in E&W.
authors.affiliation: HIV and STI Department, Health Protection Agency Centre for Infections, London, UK. s.dougan@city.ac.uk
authors.forename: Sarah
authors.initials: S
authors.lastname: Dougan
authors.forename: M Adekoyejo
authors.initials: MA
authors.lastname: Balogun
authors.forename: Jonathan
authors.initials: J
authors.lastname: Elford
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Brant
authors.forename: Katy
authors.initials: K
authors.lastname: Sinka
authors.forename: Barry G
authors.initials: BG
authors.lastname: Evans
authors.forename: Mary E
authors.initials: ME
authors.lastname: Ramsay
mesh_terms: D000328:Adult; D019411:Clinical Laboratory Techniques; D015897:Comorbidity; D004739:England / Q000453:epidemiology; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D006526:Hepatitis C / Q000175:diagnosis / Q000453:epidemiology*; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D018571:Sentinel Surveillance; D015229:Sexually Transmitted Diseases, Viral / Q000175:diagnosis / Q000453:epidemiology*; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000821:virology; D065227:Transfusion Reaction; D014852:Wales / Q000453:epidemiology