Trends in hepatitis C virus infections among MSM attending a sexually transmitted infection clinic; 1995-2010.
BACKGROUND
Since 2000, there is growing evidence that hepatitis C virus (HCV) infection has emerged as a sexually transmitted infection (STI) among HIV-positive MSM. Here, we present a 15-year overview of the HCV epidemic among MSM visiting a large STI-clinic in the Netherlands.


METHODS
During biannual cross-sectional anonymous surveys (1995-2010), participants were interviewed and tested for HIV and HCV-antibodies. Additional HCV RNA tests were performed in all HIV-positives. Determinants of HCV infection were analysed using logistic regression. Phylogenetic analysis provided evidence for sexual transmission.


RESULTS
HCV prevalence among HIV-positive MSM increased from 1995 onwards (5.6%) and peaked in 2008 (20.9%). Prevalent HCV infection was more strongly associated with fisting in 2007-2008 [adjusted odds ratio (aOR) 2.85, 95% confidence interval (CI) 1.19-6.82] than in 2009-2010 (aOR 0.92, 95% CI0.42-2.02). In addition, HCV infection was independently associated with Chlamydia, injecting drug use, unprotected anal intercourse and older age. Phylogenetic analysis revealed a high degree of MSM-specific clustering from 2000 onwards. Identification of a new MSM-specific HCV lineage and the finding of recent HCV infections (0-4%) in established HCV clusters during recent years argue for ongoing transmission of HCV among HIV-positive MSM. HCV prevalence among HIV-negative MSM remained low (2007-2010: 0.5%).


CONCLUSIONS
HCV prevalence among HIV-positive MSM significantly increased over calendar time but appears to level off in recent years, possibly due to increased awareness, saturation in the population, decreased risk behaviour and earlier HCV screening and treatment. The association with fisting became less strong over time, but our analyses continue to support sexual transmission. Monitoring HIV-positive and HIV-negative MSM for HCV infection remains needed to guide prevention efforts.
aAmsterdam Public Health Service, Cluster of Infectious Diseases bSanquin Blood Supply Foundation, Department of Blood-borne Infections cAcademic Medical Center (AMC), Department of Clinical Epidemiology, Biostatistics and Bioinformatics dAMC, Department of Clinical Virology, Amsterdam eNational Institute for Public Health and the Environment, Center for Infectious Disease Control, Bilthoven fAMC, Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS (CINIMA), Amsterdam gJulius Center for Health Science and Primary Care, University Medical Center, Utrecht, The Netherlands.
Anouk T
AT
Urbanus
Thijs J W
TJ
Van De Laar
Ronald
R
Geskus
Joost W
JW
Vanhommerig
Martijn S
MS
Van Rooijen
Janke
J
Schinkel
Titia
T
Heijman
Roel A
RA
Coutinho
Maria
M
Prins
D000328:Adult; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D015483:HIV Antibodies / Q000097:blood; D015658:HIV Infections / Q000150:complications*; D006526:Hepatitis C / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D018937:Hepatitis C Antibodies / Q000097:blood; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D012367:RNA, Viral / Q000097:blood; D012307:Risk Factors; D015229:Sexually Transmitted Diseases, Viral / Q000453:epidemiology* / Q000635:transmission / Q000821:virology
D015483:HIV Antibodies; D018937:Hepatitis C Antibodies; D012367:RNA, Viral