title: Hepatitis C virus infections among HIV-infected men who have sex with men: an expanding epidemic.
abstract: BACKGROUND
  Since 2000 outbreaks of sexually transmitted hepatitis C Virus (HCV) infections have been reported among HIV-infected men who have sex with men (MSM). We studied the prevalence and determinants of HCV-infection among MSM attending a large sexually transmitted infection (STI) clinic in the Netherlands.
  
  
  METHODS
  In 2007-2008, 3125 attendees of the STI clinic Amsterdam, including 689 MSM, participated in an anonymous biannual crosssectional survey. Participants were interviewed and screened for HIV and HCV antibodies. Additionally, all anti-HCV positive and HIV-infected individuals were tested for HCV RNA. Using phylogenetic analysis, HCV strains of the STI clinic attendees were compared with those isolated from MSM with acute HCV in 2000-2007. Determinants of HCV-infection were analysed using logistic regression.
  
  
  RESULTS
  Two of 532 (0.4%) HIV-negative MSM and 28 of 157 (17.8%) HIV-positive MSM were infected with HCV. Over the study period, HCV prevalence among HIV-infected MSM increased (14.6%-20.9%). Seven of 28 (25.0%) HIV/HCV coinfected MSM had acute HCV infection. Only five of 28 (17.9%) HIV/HCV coinfected MSM ever injected drugs (IDU). HIV-infection, IDU, fisting and gamma hydroxy butyrate (GHB)-use were significantly associated with HCV-infection. Phylogenetic analyses revealed a high degree of MSM-specific clustering.
  
  
  CONCLUSIONS
  We found a high and increasing HCV prevalence in HIV-infected MSM. Though not statistically significant, this trend, and the relatively large proportion of acute infections suggest ongoing transmission of HCV in HIV-positive MSM. Regardless of IDU, rough sexual techniques and use of recreational drugs were associated with HCV-infection; phylogenetic analysis supported sexual transmission. Targeted prevention, like raising awareness and routine testing, is needed to stop the further spread among HIV-infected MSM, and to prevent possible spillover to HIV-negative MSM.
authors: Cluster of Infectious Diseases, Amsterdam Public Health Service, The Netherlands. aurbanus@ggd.amsterdam.nl
authors: Anouk T
authors: AT
authors: Urbanus
authors: Thijs J
authors: TJ
authors: van de Laar
authors: Ineke G
authors: IG
authors: Stolte
authors: Janke
authors: J
authors: Schinkel
authors: Titia
authors: T
authors: Heijman
authors: Roel A
authors: RA
authors: Coutinho
authors: Maria
authors: M
authors: Prins
mesh_terms: D000328:Adult; D004196:Disease Outbreaks; D005838:Genotype; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000635:transmission; D016174:Hepacivirus / Q000145:classification / Q000235:genetics; D006526:Hepatitis C / Q000150:complications* / Q000453:epidemiology / Q000635:transmission / Q000821:virology; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010802:Phylogeny; D020133:Reverse Transcriptase Polymerase Chain Reaction / Q000379:methods; D012307:Risk Factors; D012309:Risk-Taking; D047568:Unsafe Sex