The epidemic of sexually transmitted hepatitis C virus amongst HIV-positive gay men appears to be gaining a foothold in southern Europe, according to a study presented to the Fourth International Workshop on HIV and Hepatitis Coinfection in Madrid.
Outbreaks of sexually transmitted hepatitis C virus amongst HIV-positive gay men have been reported in the UK, Netherlands and Germany. Although there are high rates of HIV/hepatitis C coinfection in southern Europe, this is due to injection drug use and it appeared that there was little evidence of sexual transmission of hepatitis C.
But now investigators in Milan have found convincing evidence of sexual transmission of hepatitis C amongst HIV-positive gay men in the city, particularly after 2006.
Their retrospective study involved 272 gay or bisexual men who received HIV care in the city between 1996 and the end of 2007. All these individuals had at least two hepatitis C antibody tests allowing the investigators to gain an understanding of the incidence of new hepatitis C infections.
A total of 21 men were found to have been infected with hepatitis C during the time period under analysis. There were no infections in the period before 2000, matching the epidemiology of the infection in HIV-positive gay men in northern Europe. But three men (4%) became infected with hepatitis C between 2001 and 2005. The outbreak gathered pace after 2006 with 18 new infections (12%) by the end of 2007.
Median age of the men diagnosed with new hepatitis C infection was 40 years. None of the patients cleared the infection spontaneously. Only five patients accepted hepatitis C therapy, resulting in the clearance of the infection in two patients.
Syphilis was also present in a third of patients at the time of hepatitis C diagnosis. None of the cases seen before 2005 involved concurrent syphilis infection. The cluster of hepatitis C and syphilis concomitant infections in 2006 – 07 could indicate the transmission of these infections within sexual networks. Such a hypothesis is supported by evidence from northern Europe where high rates of sexually transmitted infections, notably syphilis, were seen in HIV-positive gay men with recent hepatitis C infections.
The investigators recommend that HIV-positive gay men with risky sexual behaviours should be considered for regular hepatitis C screening. Such screening is already recommended in the UK and has helped detect incident hepatitis C infections in this population.
Gallotta G. et al. Acute hepatitis C virus in HIV co-infected men who have sex with men: Milan, 1996 – 2007. Fourth International Workshop on HIV and Hepatitis Coinfection, Madrid, abstract 47, 2008.