title: Prevalence of hepatitis C in a Swiss sample of men who have sex with men: whom to screen for HCV infection?
abstract: BACKGROUND
  While the numbers of hepatitis-C-virus (HCV) infections among men who have sex with men (MSM) who are co-infected with the human immunodeficiency virus (HIV) are on the rise, with vast evidence for sexual transmission of HCV in this population, concerns have also been raised regarding sexual HCV-transmission among MSM without HIV infection. Therefore, the aim of this study was to estimate the prevalence of hepatitis C among MSM without HIV diagnosis in Zurich (Switzerland).
  
  
  METHODS
  Participants were recruited from a gay health centre and various locations such as dark rooms, saunas and cruising areas in Zurich. Participants self-completed a questionnaire assessing known and suspected risk factors for HCV-infection, and provided a blood sample for detection of past (antibodies) and present (core antigen, RNA) infections with HCV.
  
  
  RESULTS
  In total, 840 MSM aged 17-79 (median: 33 years) underwent HCV-testing and completed the questionnaire, among whom 19 reported living with HIV. Overall, seven tested positive for HCV-antibodies, and two were also positive for HCV core antigen and HCV-RNA-these two were immigrants, one from a country where HCV is endemic. None of the seven were aware of their infection. The seroprevalence of hepatitis C among the 821 non-HIV-diagnosed MSM was 0.37% (95%-CI: 0.12-1.69%), and one man harboured replicating virus (0.12%; 0.02-0.69%), resulting in a number needed to test of 821 to detect one active infection. Significant univariable associations of lifetime HCV-infection were found with known HIV-diagnosis (OR=72.7), being tattooed (OR=10.4), non-injection use of cocaine/amphetamines (OR=8.8), and non-Swiss origin (OR=8.5). For MSM without HIV-diagnosis, the only variable marginally associated with positive HCV-serostatus was being tattooed (OR=8.3). No significant associations were observed with reported injection drug use, unprotected anal intercourse, sexual practices that may lead to mucosal trauma, or proxy measures for group sex and lesion-prone STIs.
  
  
  CONCLUSIONS
  Our findings suggest that in Switzerland, hepatitis C among MSM without diagnosed HIV is not more prevalent than in the general population. We found no evidence of elevated rates of sexual transmission of HCV among MSM without HIV-infection. Therefore, we currently see no reason for promoting HCV-testing among all MSM in Switzerland.
authors.affiliation: Checkpoint Zurich, Konradstrasse 1, 8005 Zurich, Switzerland. axel.j.schmidt@emis-project.eu.
authors.forename: Axel J
authors.initials: AJ
authors.lastname: Schmidt
authors.forename: Luis
authors.initials: L
authors.lastname: Falcato
authors.forename: Benedikt
authors.initials: B
authors.lastname: Zahno
authors.forename: Andrea
authors.initials: A
authors.lastname: Burri
authors.forename: Stephan
authors.initials: S
authors.lastname: Regenass
authors.forename: Beat
authors.initials: B
authors.lastname: Müllhaupt
authors.forename: Philip
authors.initials: P
authors.lastname: Bruggmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D060085:Coinfection; D005006:Ethnicity; D015658:HIV Infections / Q000150:complications; D016174:Hepacivirus; D006526:Hepatitis C / Q000453:epidemiology* / Q000821:virology; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D012725:Sexual Behavior; D015819:Substance Abuse, Intravenous / Q000453:epidemiology; D013557:Switzerland / Q000453:epidemiology; D055815:Young Adult