title: Shedding of Hepatitis C Virus Into the Rectum of HIV-infected Men Who Have Sex With Men.
abstract: BACKGROUND
  For over a decade we have known of an epidemic of sexually transmitted hepatitis C virus (HCV) infection among human immunodeficiency virus (HIV)-infected men who have sex with men (MSM), but there still remains significant controversy over which bodily fluid(s) are responsible for HCV transmission in these men.
  
  
  METHODS
  We enrolled HIV-infected MSM with recent and chronic HCV infection and quantified HCV from rectal fluid obtained by blind swab. We compared the rectal HCV viral load (VL) with paired blood HCV VL.
  
  
  RESULTS
  We found rectal HCV shedding in 20 (47%) of 43 men, only one (2%) of whom had visible bleeding. Detection of rectal HCV shedding was associated with blood VL > 5 log10IU/mL (p = .01), and 85% with blood VL > 5 log10IU/mL had rectal shedding. The HCV VL of the rectal fluid ranged from 2.6 to 5.5 log10IU/mL. Based on the median rectal fluid VL, the surface of an average human penis would be exposed to at least 2,300 IU of HCV for the duration of anal intercourse.
  
  
  CONCLUSIONS
  This study provides the first direct evidence to our knowledge that a sufficient quantity of HCV is shed into the rectum in HIV-infected men with HCV infection to directly infect an inserted penis or be passed indirectly through fomite-like transmission to the rectum of sex partner. We must develop an appropriate public health campaign to educate MSM about these routes of HCV infection to reverse the HCV epidemic among HIV-infected MSM.
authors.affiliation: Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Foster
authors.affiliation: Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Gaisa
authors.affiliation: Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Rosanne M
authors.initials: RM
authors.lastname: Hijdra
authors.affiliation: Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Turner
authors.affiliation: Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Tristan J
authors.initials: TJ
authors.lastname: Morey
authors.affiliation: Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Karen B
authors.initials: KB
authors.lastname: Jacobson
authors.affiliation: Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York daniel.fierer@mssm.edu.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Fierer
mesh_terms: D000328:Adult; D015658:HIV Infections / Q000150:complications*; D016174:Hepacivirus / Q000302:isolation & purification / Q000502:physiology*; D006526:Hepatitis C / Q000097:blood / Q000150:complications* / Q000635:transmission*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City; D012007:Rectum / Q000821:virology*; D012307:Risk Factors; D019562:Viral Load; D017201:Virus Shedding
keywords: HIV-infected MSM; hepatitis C virus (HCV); rectum; sexual transmission; shedding