title: Trouble with bleeding: risk factors for acute hepatitis C among HIV-positive gay men from Germany--a case-control study.
abstract: OBJECTIVE
  To identify risk factors for hepatitis C among HIV-positive men who have sex with men (MSM), focusing on potential sexual, nosocomial, and other non-sexual determinants.
  
  
  BACKGROUND
  Outbreaks of hepatitis C virus (HCV) infections among HIV-positive MSM have been reported by clinicians in post-industrialized countries since 2000. The sexual acquisition of HCV by gay men who are HIV positive is not, however, fully understood.
  
  
  METHODS
  Between 2006 and 2008, a case-control study was embedded into a behavioural survey of MSM in Germany. Cases were HIV-positive and acutely HCV-co-infected, with no history of injection drug use. HIV-positive MSM without known HCV infection, matched for age group, served as controls. The HCV-serostatus of controls was assessed by serological testing of dried blood specimens. Univariable and multivariable regression analyses were used to identify factors independently associated with HCV-co-infection.
  
  
  RESULTS
  34 cases and 67 controls were included. Sex-associated rectal bleeding, receptive fisting and snorting cocaine/amphetamines, combined with group sex, were independently associated with case status. Among cases, surgical interventions overlapped with sex-associated rectal bleeding.
  
  
  CONCLUSIONS
  Sexual practices leading to rectal bleeding, and snorting drugs in settings of increased HCV-prevalence are risk factors for acute hepatitis C. We suggest that sharing snorting equipment as well as sharing sexual partners might be modes of sexual transmission. Condoms and gloves may not provide adequate protection if they are contaminated with blood. Public health interventions for HIV-positive gay men should address the role of blood in sexual risk behaviour. Further research is needed into the interplay of proctosurgery and sex-associated rectal bleeding.
authors.affiliation: Department for Infectious Diseases Epidemiology, Robert Koch Institute, Berlin, Germany. a.j.schmidt@rki.de
authors.forename: Axel J
authors.initials: AJ
authors.lastname: Schmidt
authors.forename: Jürgen K
authors.initials: JK
authors.lastname: Rockstroh
authors.forename: Martin
authors.initials: M
authors.lastname: Vogel
authors.forename: Matthias
authors.initials: M
authors.lastname: An der Heiden
authors.forename: Armin
authors.initials: A
authors.lastname: Baillot
authors.forename: Ivanka
authors.initials: I
authors.lastname: Krznaric
authors.forename: Doris
authors.initials: D
authors.lastname: Radun
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D017280:Condoms; D003428:Cross Infection / Q000150:complications; D003710:Demography; D005858:Germany / Q000453:epidemiology; D006679:HIV Seropositivity / Q000150:complications*; D007722:Health Knowledge, Attitudes, Practice; D006470:Hemorrhage / Q000150:complications*; D006526:Hepatitis C / Q000150:complications* / Q000453:epidemiology*; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D055815:Young Adult