Sexual Transmission of HCV among HIV Positive Men Who Have Sex with Men in France  

By Liz Highleyman

Since the early 2000s, there have been several reports of clusters of apparently sexually transmitted acute hepatitis C virus (HCV) infection among mostly HIV positive men who have sex with men (MSM) in large cities in the U.K. and Europe.

At the 58th Annual Meeting of the American Association for the Study of Liver Diseases in Boston (November 2-6, 2007), researchers reported further evidence of HCV sexual transmission among MSM in France.

The investigators conducted a prospective study during 2006 and 2007 to describe clinical and epidemiological characteristics of MSM with acute hepatitis C and to evaluate the incidence of HCV in this population. Preliminary results were presented at the conference.

A random and proportional probability sample of 84 medical wards was drawn according to the number of HIV and AIDS cases in MSM reported to the French National HIV surveillance system since 2003. Acute HCV infection was defined as a positive anti-HCV antibody test or detectable HCV RNA by PCR within 1 year of a documted negative antibody test.

Information was collected on sociodemographic, clinical, and biological factors related to acute HCV, HBV, and HIV infection. Two types of questionnaires were used: a survey for physicians to collect clinical data and HCV risk factors, and a self-administered survey for patients about sexual behavior, HCV risk factors, and potential exposures.

Results

 • Between January 2006 and May 2007, 43 out of the 49 patients meeting the case definition of acute HCV were included, most (72 %) in Paris.

 • The median age at HCV diagnosis was 38 years (range 26-58 years).

 • The median duration of HIV infection was 6.5 years (range 0-22 years).

 • HCV was suspected due to elevated ALT in 72% of the patients.

 • 66% had asymptomatic HIV infection and 72% of treated patients (16 out of 22) had undetectable HIV viral load.

 • 66% of the patients with available HCV genotype information (21 out of 32) were infected with genotype 4; this genotype represents only 10% of the total HCV cases in France.

 • Self-administered questionnaires available for 27 patients describing risk factors during the 6-month period prior to HCV infection revealed the following:

 • The median number of sexual partners was 20 (range 0-170);

 • 81% engaged in unprotected anal sex;

 • 41% experienced bleeding during anal sex;

 • 74% had other sexually transmitted infections;

 • 63% used recreational drugs (e.g., ecstasy, cocaine) before having sex.

 Conclusion

“In France, HIV positive MSM with frequent unprotected anal sex together with [sexually transmitted infections] and mucosal trauma may be at risk of sexual HCV transmission,” the researchers concluded. “Therefore, it is necessary to reinforce prevention strategies targeted to this population.”

The fact that two-thirds of the men had the unusual genotype 4 provides further evidence of transmission within a sexual network. A recent analysis of relationships between HCV strains involved in recent acute hepatitis C outbreaks in France, Germany, the Netherlands, and the U.K. indicates that sexual transmission appears to be occurring between MSM in different countries.

11/30/07

Reference
C Larsen, L Alric, I Auperin, and others. Acute hepatitis C in HIV-infected men who have sex with men in France in 2006 and 2007. 58th Annual Meeting of the American Association for the Study of Liver Diseases. Boston, MA, November 2-6, 2007. Abstract 894.