title: Scaling up epidemics of acute hepatitis C and syphilis in HIV-infected men who have sex with men in Spain.
abstract: BACKGROUND
  Outbreaks of acute hepatitis C in HIV-positive men who have sex with men (MSM) are being reported in large cities in western countries along with increasing rates of sexually transmitted diseases.
  
  
  METHODS
  All HIV individuals attended at a large outclinic in Madrid within the last 5 years were examined. Incident syphilis was diagnosed based on rapid plasma reagin (RPR) reactivity, being negative previously or showing >4-fold increase. Acute hepatitis C was diagnosed based on HCV antibody seroconversion and/or positive serum HCV-RNA after being negative within the last year.
  
  
  RESULTS
  A total of 859 episodes of syphilis and 19 of acute hepatitis C were diagnosed during the study period. Syphilis was recognized in 65/2,094 (3.1%) individuals attended in 2008 and rose up to 261/2,512 (10.4%) in 2012 (P < 0.001). Acute hepatitis C was diagnosed in only one subject in 2008 but rose up to 7 in 2012 (P = 0.12). All 19 HIV patients with acute hepatitis C were MSM. Syphilis was diagnosed concomitantly in seven. All eight individuals who were treated with peginterferon/ribavirin were cured, whereas only one untreated experienced spontaneous clearance (P = 0.004). Two clusters of infections by HCV genotypes 4 and 1a were identified by phylogenetic analyses.
  
  
  CONCLUSIONS
  The incidence of acute hepatitis C is low but steadily increasing in HIV-positive MSM in Madrid (<1% yearly), despite the very high rates of syphilis (currently 20% yearly in HIV-positive MSM). Preventive measures for sexually transmitted infections and periodic HCV screening are warranted in this population as treatment of acute hepatitis C is very effective.
authors.affiliation: Department of Infectious Diseases, Hospital Carlos III, Madrid, Spain.
authors.forename: Clara
authors.initials: C
authors.lastname: Sánchez
authors.forename: Zulema
authors.initials: Z
authors.lastname: Plaza
authors.forename: Eugenia
authors.initials: E
authors.lastname: Vispo
authors.forename: Carmen
authors.initials: C
authors.lastname: de Mendoza
authors.forename: Pablo
authors.initials: P
authors.lastname: Barreiro
authors.forename: José V
authors.initials: JV
authors.lastname: Fernández-Montero
authors.forename: Pablo
authors.initials: P
authors.lastname: Labarga
authors.forename: Eva
authors.initials: E
authors.lastname: Poveda
authors.forename: Vincent
authors.initials: V
authors.lastname: Soriano
mesh_terms: D001483:Base Sequence; D016000:Cluster Analysis; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology*; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008969:Molecular Sequence Data; D010802:Phylogeny; D011935:Reagins / Q000097:blood; D020133:Reverse Transcriptase Polymerase Chain Reaction; D017422:Sequence Analysis, DNA; D013030:Spain / Q000453:epidemiology; D013587:Syphilis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D017361:Viral Nonstructural Proteins / Q000235:genetics; D012324:RNA-Dependent RNA Polymerase
chemical_list: D011935:Reagins; D017361:Viral Nonstructural Proteins; C087036:NS-5 protein, hepatitis C virus; D012324:RNA-Dependent RNA Polymerase
keywords: HIV; acute hepatitis C; interferon; men who have sex with men; ribavirin; syphilis